physiology of the cardiac system
TRANSCRIPT
8/11/2019 Physiology of the Cardiac System
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PHYSIOLOGY OF THE CARDIAC
SYSTEM
DR PINKI TAK
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ISOVOLUMETRIC RELAXATIONRAPID INFLOW
DIASTASIS ATRIAL SYSTOLE
EJECTION
ISOVOLUMETRICCONTRACTION
SYSTOLE DIASTOLE SYSTOLE
AORTICPRESSURE
ATRIALPRESSURE
VENTRICLEPRESSURE
ECG
PHONO-CARDIOGAM
V O L U M
E ( m l )
P R E
S S U R E ( m m H g )
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THE CARDIAC CYCLE
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ATRIAL SYSTOLE
The end of diastole
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ATRIAL SYSTOLE - Heart
Prior to atrial systole, blood hasbeen flowing passively from theatrium into the ventricle throughthe open AV valve.
During atrial systole the atriumcontracts and tops off the volumein the ventricle with only a smallamount of blood. Atrialcontraction is complete before the
ventricle begins to contract.
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ATRIAL SYSTOLE
Pressures & Volumes
The "a" wave occurs when theatrium contracts, increasing atrialpressure (yellow).
Blood arriving at the heart cannotenter the atrium so it flows back upthe jugular vein, causing the firstdiscernible wave in the jugular
venous pulse. Atrial pressure drops when the
atria stop contracting. During atrial systole the atrium
contracts and tops off the volumein the ventricle with only a smallamount of blood.
Atrial contraction is completebefore the ventricle begins tocontract.
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ATRIAL SYSTOLE
ECG
An impulse arising from the SA node results in depolarization andcontraction of the atria (the right atrium contracts slightly before theleft 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.
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ATRIAL SYSTOLE
Heart Sounds
A fourth heart sound (S4) is abnormal and is associated with the end ofatrial emptying after atrial contraction.
It occurs with hypertrophic congestive heart failure, massive pulmonary
embolism, tricuspid incompetence, or cor pulmonale.
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ISOVOLUMETRIC CONTRACTION
The Beginning of systole
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ISOVOLUMETRIC CONTRACTION
Heart
The atrioventricular (AV) valvesclose at the beginning of thisphase.
Electrically, ventricular systole is
defined as the interval between theQRS complex and the end of the T
wave (the Q-T interval).
Mechanically, ventricular systole isdefined as the interval between the
closing of the AV valves and theopening of the semilunar valves(aortic and pulmonary valves).
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ISOVOLUMETRIC CONTRACTION
Pressures & Volumes
The AV valves close when thepressure in the ventricles (red)exceeds the pressure in the atria(yellow).
As the ventricles contractisovolumetrically -- their volumedoes not change (white) -- thepressure inside increases,approaching the pressure in the
aorta and pulmonary arteries(green).
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ISOVOLUMETRIC CONTRACTION
ECG
The electrical impulse propagates from the AV node through the Hisbundle and Purkinje system to allow the ventricles to contract from theapex of the heart towards the base.
The QRS complex is due to ventricular depolarization, and it marks thebeginning of ventricular systole. It is so large that it masks theunderlying atrial repolarization signal. the ventricles to fill completely
with blood.
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ISOVOLUMETRIC CONTRACTION
Heart Sounds
The first heart sound (S1, "lub") is due to the closing AV valves andassociated blood turbulence.
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RAPID EJECTION
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RAPID EJECTION
Heart
The semilunar (aortic andpulmonary) valves open at thebeginning of this phase.
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RAPID EJECTION
Pressures & Volumes
While the ventricles continuecontracting, the pressure in the ventricles(red) exceeds the pressure in the aortaand pulmonary arteries (green); thesemilunar 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 ofblood reaches a peak.
The "c" wave of atrial pressure is notnormally discernible in the jugular
venous pulse. Right ventricular
contraction pushes the tricuspid valveinto the atrium and increases atrialpressure, creating a small wave into the
jugular vein. It is normally simultaneous with the carotid pulse.
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RAPID EJECTION
ECG
No Deflections
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RAPID EJECTION
Heart Sounds
None
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REDUCED EJECTION
The end of systole
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REDUCED EJECTION
Heart
At the end of this phase thesemilunar (aortic and pulmonary)
valves close.
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REDUCED EJECTION
Heart Sounds
None
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ISOVOLUMETRIC RELAXATION
The beginning of Diastole
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ISOVOLUMETRIC RELAXATION
Heart
At the beginning of this phase the AV valves are closed.
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ISOVOLUMETRIC RELAXATION
Pressures & Volumes
Throughout this and the previoustwo phases, the atrium in diastolehas been filling with blood on topof the closed AV valve, causingatrial 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 seconddiscernible 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 filledagain with blood.
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ISOVOLUMETRIC RELAXATION
ECG
No Deflections
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RAPID VENTRICULAR FILLING
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RAPID VENTRICULAR FILLING
Heart
Once the AV valves open, bloodthat has accumulated in the atriaflows rapidly into the ventricles.
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RAPID VENTRICULAR FILLING Pressures
& Volumes
Ventricular volume (white)increases rapidly as blood flowsfrom the atria into the ventricles.
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RAPID VENTRICULAR FILLING ECG
No Deflections
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RAPID VENTRICULAR FILLING
Heart Sounds
A third heart sound (S3) is usually abnormal and is due to rapidpassive ventricular filling. It occurs in dilated congestive heart
failure, severe hypertension, myocardial infarction, or mitralincompetence.
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REDUCED VENTRICULAR FILLING
(Diastasis)
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REDUCED VENTRICULAR FILLING
Heart
Rest of blood that has accumulatedin the atria flows slowly into the
ventricles.
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REDUCED VENTRICULAR FILLING
ECG
No Deflections
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REDUCED VENTRICULAR FILLING
Heart Sounds
None
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