2. Events of the Cardiac Cycle

3. Why did the blood flow across the valve? Desire - it wanted to Ability - it could do it Movement = Desire X Ability Flow = Driving Pressure X Conductance Flow = Driving Pressure X 1 Resistance

4. A B Driving Pressure = ∆P driving = P A -P B

5. DiastoleSystole Measure: ECG Sound Pressure Aorta Left Atrium

6. Measuring Left Atrial Pressure

8. P A = QR + P B P A - P B = Q X R.

9. DiastoleSystole Measure: ECG Sound Pressure Aorta Left Atrium Left Ventricle Volume of Left Ventricle Valves Flow of Blood Cardiac Muscle Tension

10. Diastasis Passive Ventricular Filling

11. Time (s)00.20.80.6 120 80 40 00 4 8 12 16 150 100 50 0 Left Ventricle Volume (ml) Pressure Sounds ECG mmHgkPa P wave Aorta Left Ventricle Left Atrium

12. Atrial Depolarization at the end of diastasis

13. Atrial Systole contraction of atrial muscle

14. Time (s)00.20.80.6 120 80 40 00 4 8 12 16 150 100 50 0 Left Ventricle Volume (ml) Pressure Sounds EKG mmHgkPa Phase Aorta Left Atrium Left Ventricle QRS 4 a wave Atrial Systole End-diastolic LV Pressure

15. Isovolumic Ventricular Contraction contraction of ventricular muscle - all valves closed

16. Time (s)00.20.80.6 120 80 40 00 4 8 12 16 150 100 50 0 Left Ventricle Volume (ml) Pressure Sounds EKG mmHgkPa Phase Aorta 1 Isovolumic Contraction Slope = LV dp/dt End-diastolic LV Volume mitral closes Left Ventricle Left Atrium

17. Rapid Ejection Ventricular Contraction: Semi-lunar valves open

18. Time (s)00.20.80.6 120 80 40 00 12 16 150 100 50 0 Left Ventricle Volume (ml) Pressure Sounds EKG mmHgkPa Phase Left atrium Diastolic arterial pressure C wave 4 8 Rapid Ejection Left Ventricle Aortic valve opens

19. Reduced Ejection Ventricular still contracting but arterial pressure is now falling

20. Time (s)00.20.80.6 120 80 40 00 12 16 150 100 50 0 Left Ventricle Volume (ml) Pressure Sounds EKG mmHgkPa Phase 4 8 End systolic LV pressure Reduced Ejection Aortic Valve Closes 2 T wave Systolic arterial pressure Arterial pulse pressure

21. Isovolumic Relaxation Ventricular Muscle relaxing: All valves closed

22. Time (s)00.20.80.6 120 80 40 00 12 16 150 100 50 0 Left Ventricle Volume (ml) Pressure Sounds EKG mmHgkPa Phase 4 8 Aortic Valve Closes Isovolumic Relaxation End-systolic volume Stroke volume Mitral Valve Opens Ejection Fraction = Stroke Volume End-diastolic volume Incisura

23. Rapid Ventricular Filling Ventricular Filling as Muscle Relaxes

24. Time (s)00.20.80.6 120 80 40 00 12 16 150 100 50 0 Left Ventricle Volume (ml) Pressure Sounds EKG mmHgkPa 4 8 Rapid filling (Early diastole) Mitral Valve Opens v wave 3

25. Diastasis Passive Ventricular Filling

26. Time (s)00.20.80.6 120 80 40 00 12 16 150 100 50 0 Left Ventricle Volume (ml) Pressure Sounds EKG mmHgkPa 4 8 Diastasis

27. Time (s)00.20.80.6 80 40 00 12 150 100 50 0 Left Ventricle Volume (ml) Pressure Sounds EKG mmHg kPa 4 8 a v c 1 2 3 P QRS T EDV ESV SAP DAP EDLVP ESLVP MO MC AO AC 16 120

28. Aorta Left Ventricle Right Ventricle Pulmonary Artery LA RA Splitting of 2nd Heart Sound

30. A. Mitral regurgitation 100 0 200 16 8 4 0 12 mmHg kPa 80 40 0 120 Left Ventricle Volume (ml) Pressure Sounds EKG

31. Aortic Insufficiency B. 100 0 200 16 8 4 0 12 mmHg kPa 80 40 0 120 Left Ventricle Volume (ml) Pressure Sounds EKG

32. Mitral Stenosis C 100 0 200 16 8 4 0 12 mmHg kPa 80 40 0 120 Left Ventricle Volume (ml) Pressure Sounds EKG

33. Aortic Stenosis D. kPa 100 0 150 16 8 4 0 12 mmHg 80 40 0 120 Left Ventricle Volume (ml) Pressure Sounds EKG 50 160 20

34. Isovolumic contraction Rapid Filling Isovolumic relaxation Rapid Ejection Reduced Ejection Aortic valve closes Aortic valve opens Mitral valve closes Mitral valve opens Diastasis & Atrial Systole

35. Stroke Volume End Diastolic Volume & Pressure Diastolic arterial blood pressure End Systolic Volume & Pressure Systolic arterial blood pressure

36. Stroke Work Stroke Volume Mean Ventricular Ejection Pressure Stroke Work X Heart Rate = Minute Work External Work of the Heart

37. Internal Work of the Heart Non-contractile metabolic needs Contractile energy not transferred to the blood Internal Work Depends on Pressure Generated Ventricular Radius