Cardiac Cycle

Cardiac cycle
The stages of the cardiac cycle can be roughly divided into the four stages:
 Filling phase – the ventricles fill during diastole and atrial systole
 Isovolumetric contraction – the ventricles contract, building up pressure ready to pump blood
into the aorta/pulmonary trunk
 Outflow phase – the ventricles continue to contract, pushing blood into the aorta and the
pulmonary trunk. Also known as systole
 Isovolumetric relaxation – the ventricles relax, ready to re-fill with blood in the next filling phase
Filling Phase
The ventricles are filled with blood in two stages – diastole (heart relaxation) and atrial systole
(contraction of the atria).
In diastole both the atria and the ventricles are relaxed. Blood flows from the vena cava and pulmonary
veins into the right and left atria respectively, before flowing directly into the ventricles. The ventricles
fill with blood at a steadily decreasing rate, until the pressure in the ventricles is equal to that in the
veins.
At the end of diastole the atria contract, squirting a small amount of extra blood into the ventricles. This
increases the pressure in the ventricles so that it is now higher than that in the atria, causing the
atrioventricular valves (mitral/tricuspid) to close.
Isovolumetric Contraction
As contraction begins both sets of valves are closed, meaning that no blood can escape from the
ventricles. The start of systole therefore massively increases the pressure within the ventricles, ready to
eject blood into the aorta and pulmonary trunk. The stage of isovolumetric contraction lasts for
approximately 50ms while the pressure builds.
Outflow Phase
Once the pressure in the ventricles exceeds the pressure in the aorta/pulmonary trunk the outflow
valves (aortic/pulmonary) open. Blood is pumped from the heart into the great arteries.
At the end of systole, around 330ms later, the ventricles begin to relax and this decrease in pressure
compared to the aorta causes the valves to close. As well as this, blood begins to flow backwards
through the outflow valves, which also contributes to the closure of the valves.
Isovolumetric Relaxation
At the end of the outflow phase both sets of valves are closed once again. The ventricles begin to relax,
reducing the pressure in the ventricles so that the atrioventricular valves open. The ventricles then begin
to fill with blood and the cycle begins once again.
Wiggers Diagram
The American-born physiologist Dr. Carl J Wiggers has provided many health care students over the past
100 years with a unique tool to understand the cardiac cycle. The Wiggers diagram highlights the
relationship between pressure and volume over time, along with the electrical activity of the heart. The
diagram uses the left chambers of the heart to demonstrate:
Aortic pressure
Atrial pressure
Ventricular pressure
Ventricular volume
Electrocardiogram (ECG)
Phonocardiogram (heart sounds)

Frank-Starling mechanism
The heart has a remarkable capacity to accommodate an increased volume of blood coming into the
heart. In fact, increasing the end-diastolic volume also results in an increase in cardiac output. This
principle has been described by two renowned physiologists, and therefore referred to as the Frank-
Starling mechanism of the heart. The underlying principle is that the heart will pump all the blood that
returns to it by way of the veins, within physiological limits.
When there is an increase in ventricular preload, the ventricle is distended and by extension, the
myocardiocytes are also stretched. This distension brings the actin and myosin components of the
muscle fiber to a more optimal degree. Consequently, the muscle fibers will contract with a greater
force in order to pump the extra blood. Note, however, that this principle is only valid up to an optimal
point. Any further distension beyond that point will dissociate the actin-myosin complex, making it
difficult for a contraction to occur.
SOURCES: GANONG’S PHYSIOLOGY

Cardiac Cycle

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Cardiac cycle

Phonocardiogram (heart sounds)

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