Cardiac Cycle

The cardiac cycle consists of several distinct phases, encompassing both systole
(contraction) and diastole (relaxation) of the heart chambers. Here are the key
phases of the cardiac cycle:

1. Atrial Contraction (Atrial Systole):

• Initiated by the depolarization of the atria (P-wave on the ECG).
• Atria contract, pushing blood into the ventricles.
• Represents the final phase of ventricular filling.
2. Isovolumetric Contraction (Ventricular Systole - First Phase):
• Ventricles begin to contract.
• AV valves close to prevent blood backflow into the atria.
• Ventricular volume remains constant (isovolumetric) until pressure
exceeds atrial pressure.
3. Ejection Phase (Ventricular Systole - Second Phase):
• Ventricular pressure surpasses arterial pressure.
• Semilunar valves open, allowing blood to be ejected into the pulmonary
artery and aorta.
• Represents the active ejection of blood from the ventricles.
4. Isovolumetric Relaxation (Ventricular Diastole - First Phase):
• Ventricles relax, and pressure drops.
• Semilunar valves close to prevent blood backflow into the ventricles.
• Ventricular volume remains constant (isovolumetric) until atrial
pressure exceeds ventricular pressure.
5. Rapid Filling (Ventricular Diastole - Second Phase):
• AV valves open.
• Blood from the atria rapidly fills the ventricles.
• Represents the passive filling of the ventricles.
6. Atrial Diastole:
• Atria remain in diastole, receiving blood from the veins.
• Represents the period between the end of atrial contraction and the
beginning of the next atrial contraction.

Heart sounds


Image
Clinical correltion!
Murmurs

Pressure Volume Graph

A pressure-volume (PV) loop graph is a valuable tool in understanding the changes

in pressure and volume within the heart during one cardiac cycle. This loop helps
visualize various phases of the cardiac cycle and provides insights into cardiac
function. Here’s a brief explanation:

Components of a Pressure-Volume Loop:

1. Isovolumetric Contraction:
• Initial phase where ventricles contract, and the volume remains
constant (isovolumetric).
• Pressure in the ventricles rises rapidly.
2. Rapid Ejection:
• Following isovolumetric contraction, the aortic valve opens, and blood
is ejected into the aorta.
• Ventricular volume decreases, and pressure in the ventricles decreases
slightly.
3. Reduced Ejection:
• As ejection continues, the rate of blood leaving the ventricle slows.
• Ventricular pressure decreases further.
4. Isovolumetric Relaxation:
• The aortic valve closes, marking the beginning of isovolumetric
relaxation.
• Ventricular volume remains constant as the pressure decreases.
5. Rapid Filling:
• The mitral valve opens, and blood rapidly fills the ventricle.
• Ventricular volume increases, and pressure in the ventricles remains
low.
6. Reduced Filling:
• As ventricular volume increases, the rate of filling decreases.
• The ventricles reach their maximum diastolic volume.

Interpretation of the Loop:

• The loop travels counterclockwise during systole and diastole.

• The area enclosed by the loop represents stroke work, indicating the
work done by the heart to pump blood during one cardiac cycle.
• Changes in the shape and size of the loop can indicate alterations in
cardiac contractility, afterload, or preload.

From a pressure-volume (PV) loop graph, several important parameters and indices
can be derived to assess cardiac function and performance. Here are some key
derivations:

1. Stroke Volume (SV):

• Derivation: SV is the difference between end-diastolic volume (EDV) and
end-systolic volume (ESV).
• Equation: SV = EDV - ESV
• Clinical Significance: SV represents the volume of blood ejected by the
ventricle in one cardiac cycle.
2. Ejection Fraction (EF):
• Derivation: EF is the ratio of stroke volume to end-diastolic volume.
• Equation: EF = SV/EDV X 100
• Clinical Significance: EF is a crucial indicator of ventricular
function, commonly used in assessing heart failure.
3. Preload:
• Derivation: Preload is approximated by the end-diastolic volume (EDV).
• Clinical Significance: Preload represents the initial stretching of the
cardiac muscle fibers before contraction.
4. Afterload:
• Derivation: Afterload can be estimated by the systolic pressure during
ejection.
• Clinical Significance: Afterload is the resistance against which the
heart must pump blood, often associated with aortic pressure.
5. Cardiac Output (CO):
• Derivation: CO is the product of heart rate (HR) and stroke volume
(SV).
• Equation: CO= HR X SV
• Clinical Significance: CO represents the total volume of blood pumped
by the heart per minute.
6. End-Diastolic Pressure (EDP) and End-Systolic Pressure (ESP):
• Derivation: EDP is the pressure in the ventricle at the end of
diastole, and ESP is the pressure at the end of systole.
 • Clinical Significance: These pressures provide insights into
ventricular function and contractility.

Clinical importance of pressure volume graph

The pressure-volume (PV) loop graph is clinically important in understanding and

managing various cardiac conditions, including mitral stenosis, aortic stenosis,
aortic regurgitation, and mitral regurgitation. Here’s how the PV loop is
significant in each of these scenarios:

1. Mitral Stenosis:
• PV Loop Characteristics:
• Reduced stroke volume due to impaired filling of the left ventricle
during diastole.
• Elevated left atrial pressure, representing increased resistance to
blood flow through the narrowed mitral valve.
• Clinical Implications:
• The PV loop helps quantify the degree of obstruction in mitral stenosis
and guides decisions regarding intervention (e.g., mitral valve replacement or
balloon valvuloplasty).
2. Aortic Stenosis:
• PV Loop Characteristics:
• Increased afterload as the ventricle works against a narrowed aortic
valve.
• Concentric hypertrophy of the left ventricle due to the increased
workload.
• Clinical Implications:
• PV loop analysis aids in evaluating the severity of aortic stenosis and
helps determine the appropriate timing for intervention (e.g., aortic valve
replacement).
3. Aortic Regurgitation:
• PV Loop Characteristics:
• Elevated end-diastolic volume due to regurgitation of blood back into
the left ventricle during diastole.
• Increased stroke volume as the ventricle compensates for the
regurgitant volume.
• Clinical Implications:
• PV loop assessment assists in quantifying the severity of aortic
regurgitation and guiding decisions regarding surgery or other interventions.
4. Mitral Regurgitation:
• PV Loop Characteristics:
• Increased end-diastolic volume due to the backflow of blood into the
left atrium during systole.
• Increased stroke volume as the ventricle accommodates the regurgitant
volume.
• Clinical Implications:
• PV loop analysis helps evaluate the impact of mitral regurgitation on
ventricular function and guides decisions regarding surgical repair or replacement
of the mitral valve.

Wigger diagram

The Wiggers diagram, developed by Carl J. Wiggers, is a visual representation of

the cardiac cycle, illustrating the dynamic changes in various cardiovascular
parameters over time. This diagram serves as a fundamental tool in comprehending
the complex interplay between electrical and mechanical events within the heart
during one complete cycle.

Key Components of the Wiggers Diagram:

 1. X-Axis (Time):
• Represents the progression of time, moving from left to right.
2. Y-Axis (Pressure):
• Reflects changes in pressure within specific regions of the heart and
major vessels.
3. Cardiac Cycle Phases:
• Atrial Contraction (P-Wave):
• Depicts the electrical activity and pressure changes during atrial
contraction, leading to ventricular filling.
• Isovolumetric Contraction (QRS Complex):
• Illustrates ventricular contraction with closed atrioventricular (AV)
valves, marking the beginning of systole.
• Ejection Phase (ST Segment to T-Wave):
• Demonstrates the ejection of blood from the ventricles into the aorta
and pulmonary artery.
• Isovolumetric Relaxation (T-Wave):
• Depicts ventricular relaxation with closed semilunar valves, marking
the end of systole.
• Rapid Filling (Late T-Wave to P-Wave):
• Represents the passive filling of the ventricles as blood flows from
the atria.
4. ECG Waveforms:
• Superimposed on the diagram to show the electrical activity of the
heart, correlating with different phases of the cardiac cycle.
5. Arterial Blood Pressure:
• Reflects changes in aortic pressure, providing insights into the
hemodynamic aspects of the cardiac cycle.

Clinical Relevance:

• Teaching Tool:
• Valuable for educating students and healthcare professionals on the
coordinated events during the cardiac cycle.
• Physiological Understanding:
• Helps in visualizing how pressure, volume, and electrical signals
correlate, deepening the understanding of cardiovascular physiology.
• Clinical Applications:
• Clinicians use the Wiggers diagram to explain and interpret
cardiovascular abnormalities and diseases.

Formulas commonly used in cardiac physiology:

1. Cardiac Output (CO):

•
• Cardiac output is the volume of blood pumped by the heart per minute.
2. Stroke Volume (SV):
•
• Stroke volume is the volume of blood ejected by the left ventricle in
one contraction.
3. Ejection Fraction (EF):
•
• Ejection fraction represents the percentage of blood ejected from the
left ventricle during systole.
4. Mean Arterial Pressure (MAP):
•
• MAP is the average arterial pressure during one cardiac cycle.
5. Cardiac Index (CI):
•
 • Cardiac index adjusts cardiac output based on body surface area.
6. Resistance (R):
•
• Resistance is the opposition to blood flow in the vessels.
7. Ohm’s Law for Circulation:
•
• Describes the relationship between pressure (), flow (), and resistance
().
8. Pulse Pressure (PP):
•
• Pulse pressure is the difference between systolic and diastolic
pressure.
9. Systemic Vascular Resistance (SVR):
•
• SVR represents the resistance in the systemic circulation.
10. Fick Principle (Oxygen Consumption):
•
• Calculates oxygen consumption based on cardiac output and arterial-
venous oxygen content difference.
11. Frank-Starling Law:
•
• Describes the relationship between preload and stroke volume.
12. Hagen–Poiseuille Equation:
•
• Describes blood flow through a cylindrical tube.
13. Resistance-Area Product (WSS):
•
• Wall shear stress describes the frictional force of blood on the vessel
wall.