Cardiovascular Physiology
Lecture 1
The cardiac cycle
Presented By:
Dr. Sally Mohamed Abd El-monem
Lecturer of Physiology
Introduction
The Cardiovascular system includes
heart and blood vessels.
Heart is a muscular organ that pumps
blood throughout the circulatory
system. It is situated in between two
lungs in the mediastinum. It is made
up of four chambers, two atria and two
ventricles.
The musculature of ventricles is
thicker than that of atria. Force of
contraction of heart depends upon the
muscles.
Vascular system
Vascular system
The heart is a dual pump
Although anatomically the heart is a single organ, the right
and left sides of the heart function as two separate pumps.
The heart is divided into right and left halves and has four
chambers, an upper and a lower chamber within each half
The upper chambers, the atria (singular, atrium), receive
blood returning to the heart and transfer it to the lower
chambers, the ventricles which pump blood from the heart.
The vessels that return blood from the tissues to the atria are
veins, and those that carry blood away from the ventricles to
the tissues are arteries.
The two halves of the heart are separated by the septum, a
continuous muscular partition that prevents blood mixing
from the two sides of the heart.
This separation is extremely important because the right side
of the heart receives and pumps O2-poor blood, whereas the
left side of the heart receives and pumps O2-rich blood.
Anatomical Overview
The two ventricles are separated by a muscular wall, the interventricular
septum.
Located between the atrium and ventricle in each half of the heart are the one-way
atrioventricular (AV) valves, which permit blood to flow from
atrium to ventricle but not backward from ventricle to atrium.
The right AV valve is called the tricuspid valve because it has three fibrous
flaps, or cusps . The left AV valve has two flaps and is therefore called the
bicuspid valve.
Anatomical Overview
The opening and closing of the AV valves are passive processes
resulting from pressure differences across the valves.
When the blood pressure in an atrium is greater than in the
corresponding ventricle, the valve is pushed open and blood flows
from atrium to ventricle.
In contrast, when a contracting ventricle achieves an internal
pressure greater than that in its connected atrium, the AV valve
between them is forced closed. Therefore, blood does not normally
move back into the atria but is forced into the pulmonary artery trunk
from the right ventricle and into the aorta from the left ventricle.
The wall of the heart
Heart is made up of three layers of tissues:
1. Outer epicardium: A thin, external layer,
the epicardium, that covers the heart formed
of the visceral pericardium
2. Middle myocardium: which is composed
of cardiac muscle and constitutes the bulk of
the heart wall (myo means “muscle”)
3. Inner endocardium: A thin, inner layer,
the endothelium, a unique type of epithelial
tissue that lines the entire circulatory system
It lines the inner surface of the heart. Then,
continues as endothelium of the blood
vessels.
The Myocardium
It is the middle layer of wall of the heart
and it is formed by cardiac muscle fibers
or cardiac myocytes.
Myocardium forms the bulk of the heart
and it is responsible for pumping action of
the heart.
Myocardium has three types of muscle
fibers:
i. Muscle fibers which form contractile
unit of heart
ii. Muscle fibers which form pacemaker
iii. Muscle fibers which form conductive
system.
Divisions of the circulation
Blood flows through two divisions of circulatory system:
1. Systemic circulation 2. Pulmonary circulation.
The Systemic circulation is otherwise known as greater
circulation.
Blood pumped from left ventricle passes through a series of
blood vessels, arterial system and reaches the tissues.
Exchange of various substances between blood and the
tissues occurs at the capillaries.
After exchange of materials, blood enters the venous system
and returns to right atrium of the heart.
From right atrium, blood enters the right ventricle. Thus,
through systemic circulation, oxygenated blood is supplied
from heart to the tissues and venous blood returns to the
heart from tissues.
Divisions of the circulation
The Pulmonary circulation is otherwise
called lesser circulation. Blood is pumped
from right ventricle to lungs through
pulmonary artery.
Exchange of gases occurs between blood
and alveoli of the lungs at pulmonary
capillaries. Oxygenated blood returns to
left atrium through the pulmonary veins.
Thus, left side of the heart contains
oxygenated or arterial blood and the right
side of the heart contains deoxygenated or
venous blood.
Thus the right side of the heart
carries de-oxygenated blood.
The left side of the heart carries
oxygenated blood.
The pulmonary veins carry
oxygenated blood from the lung
to the heart.
The pulmonary artery carries
deoxygenated blood from the
heart to the lungs.
The cardiac cycle
Cardiac cycle is defined as the sequence of events taking place in the heart
during each beat.
Duration of each cardiac cycle is about 0.8 second.
Each heartbeat consists of two major periods called systole and diastole.
During systole, heart contracts and pumps the blood through arteries.
During diastole, heart relaxes and blood is filled in the heart. All these
changes are repeated during every heartbeat, in a cyclic manner.
The duration of systole is 0.3 second
The duration of diastole 0.5 second
Cardiac output (CO): is the amount of blood pumped from each ventricle
per minute. CO = SV × Heart rate (HR) the normal co is about 5L
Stroke volume: is the amount of blood pumped out by each ventricle
during each beat.
The normal value of SV is 70 mL (60 – 80).
The cardiac cycle
Ventricular systole is divided into three subdivisions and
ventricular diastole is divided into four subdivisions.
Ventricular Systole:
1. Isometric contraction phase
2. Rapid Ejection phase
3. Reduced Ejection phase
Ventricular Diastole:
1. Isometric relaxation phase
2. Rapid filling phase
3. Slow filling phase (Diastasis)
4. Last rapid filling (atrial systole)
Among the atrial events, atrial systole occurs during the last
phase of ventricular diastole.
Atrial diastole is not considered as a separate phase, since it
coincides with the whole of phases other than last part of
ventricular diastole.
Atrial events
1- Atrial systole
Atrial systole is also known as last rapid filling phase or pre-systole.
It is usually considered as the last phase of ventricular diastole.
After slow filling period, the atria contract and push a small amount
of blood into ventricles. About 10% of ventricular filling takes place
during this period. Flow of additional amount of blood into ventricle
due to atrial systole is called atrial kick.
Duration: is 0.11 second.
Valves: A/V valves are opened, Semilunar valves are closed
Mechanically: Atrial contraction → only a last small amount, i.e.
10% of blood is forced from atria into ventricles through opened
A/V valves.
Pressure and Volume Changes: During atrial systole, the intra-
atrial pressure increases. Intraventricular pressure and ventricular
volume also increase but slightly.
Atrial events
2- Atrial Diastole
After atrial systole, the atrial diastole starts. Simultaneously,
ventricular systole also starts.
Atrial diastole lasts for about 0.7 sec.
This long atrial diastole is necessary because, this is the period
during which the atrial muscles relax and atrial filling takes place.
Right atrium receives deoxygenated blood from all over the body
through superior and inferior venae cavae.
Left atrium receives oxygenated blood from lungs through
pulmonary veins.
Out of 0.7 sec of atrial diastole, first 0.3 sec coincides with
ventricular systole. Then, ventricular diastole starts
Later part of atrial diastole coincides with ventricular diastole for
about 0.4 sec.
So, the heart relaxes as a whole for 0.4 sec.
Ventricular systole
1- Isometric contraction phase
Isometric contraction period in cardiac cycle is the first phase of ventricular systole.
Isometric contraction is the type of muscular contraction characterized by increase in
tension, without any change in the length of muscle fibers.
Immediately after atrial systole, the atrioventricular valves are closed due to increase in
ventricular pressure. Semilunar valves are already closed. Now, ventricles contract as
closed cavities, in such a way that there is no change in the volume of ventricular
chambers or in the length of muscle fibers. Only the tension increases in ventricular
musculature.
Duration: is 0.05 second.
Valves: all valves are closed
Mechanically: isometric contraction of the ventricles → rise in the ventricular pressure
without shortening of the muscle.
When the ventr. Pressure < aortic pressure → semilunar valves open in
Pressure and Volume Changes: rise in ventricular pressure with no change in volume.
Heart sounds: closure of the A/v valves -→ first heart sound.
Ventricular events
2- Rapid Ejection phase
When the ventr. Pressure < aortic pressure → semilunar valves (aortic &pulm) open → The
start of ejection phase and isotonic contraction of ventricles, blood is ejected out of both the
ventricles into aorta and pulmonary arteries.
First the ejection is rapid and a large amount of blood is rapidly ejected from both the
ventricles about 70 per cent of the blood emptying occurring during the first third then it
slows.
Duration: is 0.13 second
Valves: semilunar valves are opened, A/V valves are closed.
Mechanically: isotonic contraction of ventricles → rise in the ventricular pressure with
shortening of the muscle and ejection of about 70 % of the blood into aorta and pulmonary
arteries.
Pressure and Volume Changes: the ventricular volume rapidly decreases due to ejection ,
the vent pressure increases due to contraction
Atrial pressure initially decreased then increases due to continued venous return to atria
Aortic pressure gradually increases to a maximum .
Ventricular events
3- Reduced Ejection phase
During this stage, the blood is ejected slowly with much less force due to decreased
pressure difference between the ventricles and the large arteries. During this phase about 30
% of the blood is ejected. At the end of this phase, the volume of blood remaining in the
ventricles is called the end systolic volume ESV.
Duration: is 0.09 second.
Valves: semilunar valves are opened, A/V valves are closed
Mechanically: isotonic contraction of ventricles → rise in the ventricular pressure with
shortening of the muscle and slow ejection of about 30 % of the blood into aorta and
pulmonary arteries.
Pressure and Volume Changes: the ventricular volume further decreases due to ejection ,
the vent pressure starts to decrease
Atrial pressure still increasing due to continued venous return to atria
Aortic pressure starts to decreases due to the amount of blood entering it from the ventricle
is > the amount of blood leaving the aorta to supply all organs. .
Ventricular diastole
1- isometric relaxation phase
Due to the ejection of blood, the pressure in aorta and pulmonary artery increases and pressure in
ventricles drops. the semilunar valves close. Atrioventricular valves are already closed so the heart
is a closed chamber again, so this phase starts with semilunar valves closure.
After that isometric relaxation of the ventricles occur which is the type of muscular relaxation,
characterized by decrease in pressure without any change in the length of muscle fibers. And as all
valves are closed → no change in the volume of blood.
Valves: starts with semilunar valves closure→ so the 4 valves are closed
the AV valve is not yet open because ventricular pressure still exceeds atrial pressure, so no blood
can enter the ventricle from the atrium.
Mechanically: isotonic relaxation of ventricles → decrease in the ventricular pressure without
change in muscle length
Pressure and Volume Changes: the ventricular pressure decreases to about 0 mmhg, the vent
volume nearly constant
Atrial pressure still increasing due to continued venous return to atria
Aortic pressure decreases → dicrotic notch
Heart sounds: Closure of semilunar valves during this phase produces second heart sound
Ventricular events
2- Rapid filling phase
When the atrial Pressure < ventricular pressure → A/V valves open → The start of filling
phase and blood accumulated in the atrium during ventricular systole pours first rapidly
into the ventricles due to the increased atrial pressure. Then ventricular filling slows down
Ventricles also relax isotonically. About 70% of filling takes place during this phase,
Valves: A/V are opened, semilunar valves are closed
Mechanically: drop in the ventricular pressure below atrial pressure → a/v valve opening
→ ventricular filling
Pressure and Volume Changes: the ventricular pressure decreases then gradually
increases, the vent volume increases markedly
Atrial pressure initially increased < vent. Pressure then decreases with vent. filling
Aortic pressure gradually decreases
Heart sounds: 3rd heart sound is produced in this phase
Ventricular events
3- Reduced filling phase (diastasis)
After the sudden rush of blood, the ventricular filling becomes slow. Now, it
is called the slow filling. It is also called diastasis. About 20% of filling
occurs in this phase
Valves: A/V are opened, semilunar valves are closed
Mechanically: drop in the ventricular pressure below atrial pressure → a/v
valve opening → ventricular filling
Pressure and Volume Changes: the ventricular pressure and volume
increase at a slower rate
Atrial pressure continues to decrease but at a slower rate
Aortic pressure gradually decreases
Heart sounds: no sounds in this phase
Ventricular events
3- last rapid filling phase (atrial
systole)
Last rapid filling phase occurs because of atrial systole. After slow filling
period, the atria contract and push a small amount of blood into ventricles.
About 10% of ventricular filling takes place during this period. Flow of
additional amount of blood into ventricle due to atrial systole is called atrial
kick.
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During times of rapid heart rate, diastole length is shortened more
than systole length is.
For example, if the heart rate increases from 75 to 180 beats per
minute, the duration of diastole decreases about 75%, from 0.5 sec to
0.125 sec.
This greatly reduces the time available for ventricular relaxation and
filling. However, because much ventricular filling is accomplished
during early diastole, filling is not seriously impaired during periods
of increased heart rate, such as during exercise.
There is a limit, however, to how rapidly the heart can beat without
decreasing the period of diastole to the point that ventricular filling
is severely impaired.
At heart rates greater than 200 beats per minute, diastolic time is too
short to allow adequate ventricular filling. With inadequate filling,
