CARDIAC CYCLE

Mechanical event and their electrical

and clinical correlation
The cardiac cycle, includes both electrical and mechanical events that occur
in same order from the beginning of one heart beat to the beginning of the
next.
Each cardiac cycle consist of four basic events.
 Atrial systole
 Atrial diastole
 ventricular systole (contraction and blood ejection)
 Ventricular diastole (relaxation and blood filling)

Cardiac cycle time - time required to complete one cycle. Resting heart rate
is approximately 75 beats/min.

= 60 / HR = 60 / 75 = 0.8 sec.
 AD AS

VS VD

AS – Atrial Systole; AD – Atrial Diastole ;

VS – Ventricular systole; VD – Ventricular diastole

3
 0.7 Sec. 0.1 sec.

AD AS

VS VD

0.3Sec. 0.5 sec.

AS – Atrial Systole; AD – Atrial Diastole ;

VS – Ventricular systole; VD – Ventricular diastole

4
 .1 .1
0.7 Sec. se 0.7 Sec. se
c. c.

A A
AD AD
S S

VS VD VS VD

0.3Sec. 0.5 sec. 0.3Sec. 0.5 sec.

 .1 .1
0.7 Sec. se 0.7 Sec. se
c. c.

A A
AD AD
S S

VS VD VS VD

0.3Sec. 0.5 sec. 0.3Sec. 0.5 sec.

1 st Heart 3 rd Heart 1 st Heart 3 rd Heart

Sound Sound Sound Sound
4 th Heart 4 th Heart
Sound Sound
2 nd Heart 2 nd Heart
Sound Sound
 .1 .1
.1
s s
0.7 Sec. 0.7 Sec. 0.7 Sec. se
e e
c.
c. c.

A A A
AD AD AD
S S S

VS VD VS VD VS VD

0.3Sec. 0.5 sec. 0.3Sec. 0.5 sec. 0.3Sec. 0.5 sec.

1 st Heart 3 rd Heart 1 st Heart 3 rd Heart 1 st Heart 3 rd Heart

Sound Sound Sound Sound Sound Sound
4 th Heart th 4 th Heart
4 Heart
Sound Sound
2 nd Heart 2 nd Heart Sound 2 nd Heart
Sound Sound Sound 7
List of the features to be noted and remembered
during each phase
1. Name of the phase

2. Duration

3. Position of valves

4. Blood flow

5. Related pressure changes

6. Related volume change

7. Relation to JVP

8. Relation to ECG

9. Special points
ATRIAL SYSTOLE
 It lasts for 0.1 sec.
 Responsible for only 25 % of ventricular filling at rest and coincides with
late rapid filling phase of ventricles.
 Atrial pressure (7-8 mm in left atrium and 4-5 mm in right atrium) exceeds
ventricular pressure
 Pressure rise in right atrium is reflected into the jugular vein as a- wave.
 Responsible for S4
 Begins with peak of P wave and ends with peak of QRS complex on ECG.
 A wave on JVP
Atrial diastole
 Lasts for 0.7sec
 Follows atrial systole
 Coincides with ventricular systole and part of diastole
 During atrial diastole, atrial muscles relax and there occurs
gradual filling of the atria due to continuous venous return
and the pressure gradually increases in the atria to drop
down to almost zero with the opening of AV valves.
Ventricular systole
After the atrial contraction phase is over, the ventricles get
stimulated by the impulse travelling along the conduction system
and the ventricles start contracting. The ventricular systole lasts
for 0.3sec, and has following phases:

1. Isometric contraction period – 0.05 sec.

2. Rapid ejection period – 0.1 sec.

3. Slow/Reduced ejection period – 0.15 sec.

Isovolumic (isometric) contraction period
 In the beginning of ventricular contraction, the ventricular pressure exceeds
atrial pressure very rapidly causing closure of AV valves (first heart sound).
 Since the AV valves have closed and semilunar valves have not opened, so the
ventricles contract as a closed chamber and the pressure inside the ventricles
rises rapidly to a high level.
 As the ventricles contract, but the volume of blood in the ventricles does not
change, so this phase is called isovolumic contraction phase.
 This phase lasts for 0.05 sec, until the pressure in the left and right ventricles
exceed the pressure in the aorta (8o mm of Hg) and pulmonary artery (10 mm of
Hg) and the aortic and pulmonary valves open.
 During this phase, due to sharp rise in ventricular pressure, there occurs bulging
of AV valves into the atria increasing intra atrial pressure that produces c-wave
in JVP.
Rapid ejection phase.
 As soon as the semilunar valves open, the blood is rapidly ejected out for
about 0.1 sec.
 About two thirds of the stroke volume is ejected in this rapid ejection phase
and ventricular volume decreases.
 Pressure rises to 120mm of Hg in the left ventricle and to 25mm of Hg in the
right ventricle.
 As both the ventricles almost eject same volume of blood, the velocity of
right ventricular ejection is less than that of the left ventricle.
 Aortic pressure increases but it is less than ventricular pressure.
 Sharp decrease in atrial pressure due to descent of base of ventricle - x’
descent in JVP.
 Corresponds to ST segment of ECG
Slow/ Reduced ejection phase
 It lasts for about 0.15 sec.
 It is later half of systole during which rate of ejection declines. About one
third of the stroke volume is ejected during this phase.
 The intra ventricular pressure starts declining and falls to a value slightly
lower than in aorta, but for a short period momentum keeps the blood
flowing forward.
 Atria are relaxing and their pressure continues to increase due to venous
return and produces ‘v’ wave in JVP.
 About 50 ml of the blood is left in each ventricle at the end of systole. This
is called end-systolic volume.
 It corresponds to T- wave in ECG
120

100

80
AoV op
60

40
AV c l Left ventricular
20
pressure
0
phonocardiogram
120
100 Left ventricular
80 volume
60
40

ECG

.8 .1 .2 .3 .4 .5 .6 .7 .8 .1
 Ventricular diastole (0.5 sec) consisting of:

 Protodiastole (0.04 sec),

 Isovolumic (isometric) relaxation phase (0.06 sec),
 Early rapid filling phase (0.1 sec),
 Reduced filling phase or diastasis (0.2 sec), and
 Last rapid filling phase which coincides with the atrial systole (0.1 sec).
VENTRICULAR DIASTOLE

Protodiastole
 When the ventricular systole ends, the ventricles start relaxing and intra
ventricular pressure falls rapidly.
 This phase lasts for 0.04sec.
 During this phase the elevated pressure in the distended arteries (aorta and
pulmonary artery) immediately pushes the blood back towards ventricles
which closes semilunar valves.
 Closure of semilunar (i.e. aortic and pulmonary) valves prevents the
movement of blood back into the ventricles and produces the second heart
sound (S2).
Isovolumic relaxation phase
 This phase begins with the closure of semilunar valves and lasts for
about 0.06 sec.
 Since semilunar valves have closed and the AV valves have not yet
opened, so the ventricles continue to relax as closed chambers in this
phase. This causes rapid fall of pressure inside the ventricles (from 80
mm of Hg to about 2 to 3 mm of Hg in left ventricle.
 As in this phase, the ventricular volume remains constant, so this phase
is called isovolumic relaxation phase.
 This phase ends when the AV valves open.
 Peak of v-wave on the JVP.
Early rapid filling phase (0.1 sec)
 During ventricular systole, the atria are in diastole and venous return
continues so that the atrial pressure is high when the AV valves open. The
high atrial pressure causes a rapid, initial flow of blood into the ventricles.
 The early rapid passive filling phase produces the third heart sound (S3),
Which is not normally audible in adults but may be heard in children.
 Once the AV valves open, the atria and ventricles are a common chamber
and pressure in both cavities falls as ventricular relaxation continues.
 Reduced filling phase or diastasis (0.2 sec)

 In this phase, pressure in atria and ventricles reduces slowly and

remains little above zero. This decreases the rate of blood flow
from atria to ventricle causing a very slow filling or virtually
cessation of ventricular filling called diastasis.
Late rapid filling phase (0.1 sec)

 The late rapid filling phase of ventricular diastole coincides with the atrial
systole. As described in the beginning the atrial systole brings about the last
rapid filling phase and pushes the additional 25 per cent of the blood in the
ventricles. With this phase the ventricular cycle is completed.
 AD AS

VS VD

AS – Atrial Systole; AD – Atrial Diastole ;

VS – Ventricular systole; VD – Ventricular diastole

22
120

100 SL c l

80
SL op
60

40
AV c l AV op Left ventricular
20
pressure
0
phonocardiogram
120 Left ventricular
100
80
volume
60
40

ECG

.8 .1 .2 .3 .4 .5 .6 .7 .8 .1
 0.8
IVH.S. V

IV
0.1 I H.S.
0.7
I

0.6 0.2
II

IiI

0.3
0.5
IIIH.S. III
0.4
Ii
II H.S.
I
Jugular venous pulse
Pressure changes in the atrium are directly reflected in jugular veins.
Waves in JVP - 3 positive and 3 negative

a
c
v
x

y
X’
a – atrial systole
c – isometric contraction phase
v – atrial filling
X & X’ – atrial diastole with ventricular systole
y – rapid filling phase of ventricle