The cardiac cycle refers to the sequence of events that occur and repeat with every heartbeat. It can be divided into 2 major phases: systole and diastole, each of which subdivides into several smaller phases. Systole and diastole, when not specified otherwise, refer to ventricular contraction and relaxation, respectively. Reminders: - Blood flows from higher to lower pressure. - Contraction increases the pressure within a chamber, while relaxation lowers the pressure.
- AV valves open when atrial pressures are higher than ventricular pressures and close when the pressure gradient is reversed. Similarly, semilunar valves open when ventricular pressures are higher than aortic/pulmonary pressures, and close when the reverse is true. The cycle is initiated with the firing of the SA node that stimulates the atria to depolarize.
This is represented by the P-wave on the ECG. Atrial contraction starts shortly after the P-wave begins, and causes the pressure within the atria to increase, forcing blood into the ventricles.
Atrial contraction, however, only accounts for a fraction of ventricular filling, because at this point, the ventricles are already almost full due to passive blood flow down the ventricles through the open AV valves. As atrial contraction completes, atrial pressure begins to fall, reversing the pressure gradient across the AV valves, causing them to close.
The closing of the AV valves produces the first heart sound, S1, and marks the beginning of systole. At this point, ventricular DE-polarization, represented by the QRS complex, is halfway through, and the ventricles start to contract, rapidly building up pressures inside the ventricles. For a moment, however, the semilunar valves remain closed, and the ventricles contract within a closed space.
This phase is referred to as isovolumetric contraction because no blood is ejected and ventricular volume is unchanged. Ventricular ejection starts when ventricular pressures exceed the pressures within the aorta and pulmonary artery; the aortic and pulmonic valves open and blood is ejected out of the ventricles.
This is the rapid ejection phase. As ventricular repolarization, reflected by the T-wave, begins, ventricular pressure starts to fall and the force of ejection is reduced. When ventricular pressures drop below aortic and pulmonary pressures, the semilunar valves close, marking the end of systole and beginning of diastole.
Closure of semilunar valves produces the second heart sound, S2. The first part of diastole is, again, isovolumetric, as the ventricles relax with all valves closed. Ventricular pressure drops rapidly but their volumes remain unchanged. Meanwhile, the atria are being filled with blood and atrial pressures rise slowly. The ventricular filling starts when ventricular pressures drop below atrial pressures, causing the AV valve to open, allowing blood to flow down the ventricles passively.
The atria contract to finish the filling phase and the cycle repeats itself.
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