Cardiovascular Physiology: Lawrence A. Olatunji Reader

Cardiovascular Physiology
Lawrence A. Olatunji
Reader/Ass. Professor,
Professor
Department of Physiology, College of Health Sciences, University of
Ilorin, Ilorin/ KNU,

200L Medical students, UNILORIN
THE CARDIAC CYCLE
THE CARDIAC CYCLE
 Definition: The cyclic events that occur in the heart
chambers during each beat.
 As the normal heart rate is 72 bpm
 Each cardiac cycle includes: Atrial systole 
Ventricular systole  Diastole of whole heart.
 Blood flow in the heart is determined by pressure
difference across the orifices of the heart which leads to
opening and closure of valves.
 First and second heart sounds are due to closure of AV
and semilunar valves respectively.
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Somatic
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PHASES OF CARDIAC CYCLE
 Atrial systole: - The atria contract propelling the last 30% of its blood into ventricles.
 Ventricular Systole: [Depolarization of ventricles]
1- Isometric Contraction Phase:
- Ventricular pressure>atrial pressureAV valves close.
- Now ventricles contract as a closed chamber (all valves are closed)
- No change in volume but pressure increase.
2- Ventricular Ejection Phase:
- Ventricular pressure> aortic and pulmonary pressure semilunar valves open.
- Now blood gushes out of ventricles into aorta and pulmonary vessels
 Ventricular Diastole: [Repolarization of ventricles]
1- Isometric Relaxation Phase:

- When ventricular pressure < aortic and pulmonary artery pressure  Semilunar valves
close.
- Now ventricles relax as a closed chamber (with all valves closed)
- No change in volume but pressure decrease.
2- Ventricular Filling Phase:
- Ventricular pressure<atrial pressure AV valves open.
- Now ventricles start to fill with blood from atria.
- First 30% (rapid filling), mid 30% ( reduced filling or diastasis), last 30% (atrial systole)
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Somatic
Electrical activity- ECG
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ECG:
 The used apparatus for recording called
electrocardiograph (ECG) which has an electrode
placed on the skin and
– the recording obtained from a specific point called, a lead.
 The standard ECG has 12 different leads that record
the same electric events but from different views.
– The leads are of 3 types:-
 Bipolar limb leads.
 Unipolar leads.
 Augmented unipolar leads.
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Interpretation of ECG
 One important use of the ECG is that it lets a
physician evaluate abnormally slow, rapid, or

irregular cardiac rhythm.
 Atrial and ventricular rates of depolarization can
be determined from the frequency of P waves and
QRS complexes by recording a rhythm strip
 Under normal conditions, the heart is said to be
in sinus rhythm, because the SA node is
controlling the cardiac rhythm.
– Normal sinus rhythm can range from 60–100 bpm.
7 04/11/21
 Abnormal rhythms (arrhythmias) can be caused by
abnormal formation of APs.
 A sinus rate < 60 bpm is termed sinus bradycardia.
 may result from depressed SA nodal function.
 A sinus rate of 100–180 bpm, sinus tachycardia, is an
abnormal condition for a person at rest; however, it is a
normal response when a person exercises or becomes
excited.
 For example, atrial rate may become so high in atrial flutter (250-350
beats/min) that not all of the impulses are conducted through the AV node;
therefore, the ventricular rate (as determined by the frequency of QRS
complexes) may be only half of the atrial rate.
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ATRIAL SYSTOLE
The end of diastole

ATRIAL SYSTOLE - Heart
 Prior to atrial systole, blood has been

flowing passively from the atrium
into the ventricle through the open
AV valve.
 During atrial systole the atrium
contracts and tops off the volume in
the ventricle with only a small
amount of blood. Atrial contraction
is complete before the ventricle
begins to contract.
ATRIAL SYSTOLE
Pressures & Volumes
 The "a" wave occurs when the atrium
contracts, increasing atrial pressure
(yellow).
 Blood arriving at the heart cannot enter
the atrium so it flows back up the
jugular vein, causing the first
discernible wave in the jugular venous
pulse.
 Atrial pressure drops when the atria
stop contracting.
 During atrial systole the atrium
contracts and tops off the volume in
the ventricle with only a small amount
of blood.
 Atrial contraction is complete before
the ventricle begins to contract.
ATRIAL SYSTOLE
ECG
 An impulse arising from the SA node results in depolarization and

contraction of the atria (the right atrium contracts slightly before the left
atrium).
 The P wave is due to this atrial depolarization.
 The PR segment is electrically quiet as the depolarization proceeds to the
AV node.
 This brief pause before contraction allows the ventricles to fill completely
with blood.
ATRIAL SYSTOLE
Heart Sounds
 A fourth heart sound (S4) is abnormal and is associated with the end of
atrial emptying after atrial contraction.
 It occurs with hypertrophic congestive heart failure, massive pulmonary
embolism, tricuspid incompetence, or cor pulmonale.
ISOVOLUMETRIC
CONTRACTION
The Beginning of systole

ISOVOLUMETRIC CONTRACTION
Heart
 The atrioventricular (AV) valves
close at the beginning of this phase.
 Electrically, ventricular systole is
defined as the interval between the
QRS complex and the end of the T
wave (the Q-T interval).
 Mechanically, ventricular systole is
defined as the interval between the
closing of the AV valves and the
opening of the semilunar valves
(aortic and pulmonary valves).
Pressures & Volumes
 The AV valves close when the
pressure in the ventricles (red)
exceeds the pressure in the atria
(yellow).
 As the ventricles contract
isovolumetrically -- their volume
does not change (white) -- the
pressure inside increases,
approaching the pressure in the aorta
and pulmonary arteries (green).
ECG
 The electrical impulse propagates from the AV node through the His bundle
and Purkinje system to allow the ventricles to contract from the apex of the
heart towards the base.
 The QRS complex is due to ventricular depolarization, and it marks the
beginning of ventricular systole. It is so large that it masks the underlying
atrial repolarization signal. the ventricles to fill completely with blood.
Heart Sounds
 The first heart sound (S1, "lub") is due to the closing AV valves and
associated blood turbulence.
RAPID EJECTION
RAPID EJECTION
Heart
 The semilunar (aortic and
pulmonary) valves open at the
beginning of this phase.
RAPID EJECTION
Pressures & Volumes
 While the ventricles continue contracting,
the pressure in the ventricles (red) exceeds
the pressure in the aorta and pulmonary
arteries (green); the semilunar valves open,
blood exits the ventricles, and the volume in
the ventricles decreases rapidly (white).
 As more blood enters the arteries, pressure
there builds until the flow of blood reaches
a peak.
 The "c" wave of atrial pressure is not
normally discernible in the jugular venous
pulse. Right ventricular contraction pushes
the tricuspid valve into the atrium and
increases atrial pressure, creating a small
wave into the jugular vein. It is normally
simultaneous with the carotid pulse.
RAPID EJECTION
ECG
 No Deflections
RAPID EJECTION
Heart Sounds
 None
REDUCED EJECTION
The end of systole

REDUCED EJECTION
Heart
 At the end of this phase the
semilunar (aortic and pulmonary)
valves close.
REDUCED EJECTION
Pressures & Volumes
 After the peak in ventricular and
arterial pressures (red and green),
blood flow out of the ventricles
decreases and ventricular volume
decreases more slowly (white).
 When the pressure in the ventricles
falls below the pressure in the
arteries, blood in the arteries begins
to flow back toward the ventricles
and causes the semilunar valves to
close. This marks the end of
ventricular systole mechanically.
REDUCED EJECTION
ECG
 The T wave is due to ventricular repolarization. The end of the T wave

marks the end of ventricular systole electrically.
REDUCED EJECTION
Heart Sounds
 None
ISOVOLUMETRIC
RELAXATION
The beginning of Diastole

ISOVOLUMETRIC RELAXATION
Heart
 At the beginning of this phase the
AV valves are closed.
Pressures & Volumes
 Throughout this and the previous
two phases, the atrium in diastole has
been filling with blood on top of the
closed AV valve, causing atrial
pressure to rise gradually (yellow).
 The "v" wave is due to the back flow
of blood after it hits the closed AV
valve. It is the second discernible
wave of the jugular venous pulse.
 The pressure in the ventricles (red)
continues to drop.
 Ventricular volume (white) is at a
minimum and is ready to be filled
again with blood.
ECG
 No Deflections
Heart Sounds
 The second heart sound (S2, "dup") occurs when the semilunar (aortic
and pulmonary) valves close. S2 is normally split because the aortic
valve closes slightly earlier than the pulmonary valve.
RAPID VENTRICULAR
FILLING
RAPID VENTRICULAR FILLING
Heart
 Once the AV valves open, blood that
has accumulated in the atria flows
rapidly into the ventricles.
Pressures & Volumes
 Ventricular volume (white) increases
rapidly as blood flows from the atria
into the ventricles.
ECG
 No Deflections
Heart Sounds
 A third heart sound (S3) is usually abnormal and is due to rapid

passive ventricular filling. It occurs in dilated congestive heart failure,
severe hypertension, myocardial infarction, or mitral incompetence.
REDUCED VENTRICULAR
FILLING
(Diastasis)
REDUCED VENTRICULAR FILLING
Heart
 Rest of blood that has accumulated
in the atria flows slowly into the
ventricles.
Pressures & Volumes
 Ventricular volume (white) increases
more slowly now. The ventricles
continue to fill with blood until they
are nearly full.
ECG
 No Deflections
Heart Sounds
 None
THE COMPLETE PICTURE
QUESTIONS
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Cardiovascular Physiology

1- Isometric Relaxation Phase:

physician evaluate abnormally slow, rapid, or

The end of diastole

 Prior to atrial systole, blood has been

 An impulse arising from the SA node results in depolarization and

The Beginning of systole

The end of systole

 The T wave is due to ventricular repolarization. The end of the T wave

The beginning of Diastole

 A third heart sound (S3) is usually abnormal and is due to rapid

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