2. DR. ZAHOOR ALI SHAIKH CARDIOVASCULAR SYSTEM LECTURE - VII

3. CARDIAC CYCLE

4. Cardiac events occurring during one beat (systole & diastole) are repeated during the next beat Cardiac cycle time : 0.8 second when heart rate is 75 beats per minute.

5. We will discuss mechanical & electrical changes during Cardiac Cycle Mechanical changes: 1.Phases of cardiac cycle 2.Heart sounds 3.Pressure changes during cardiac cycle 4.Volume changes during cardiac cycle Electrical Changes 1.Electrocardiogram (ECG)‏

6. PHASES OF CARDIAC CYCLE

7. Atrial systole: 0.1 second Atrial diastole : 0.7 seconds  Ventricular systole : 0.3 seconds  Ventricular diastole : 0.5 seconds

8. Ventricular events Ventricular systole 1.Isovolumetric contraction 2.Ejection phase Rapid ejection Slow ejection Protodiastolic phase Ventricular Diastole 1.Isovolumetric relaxation phase 2.Filling phase Rapid filling Slow filling Last rapid filling

11. Q: Which Valves are open/closed during Isovolumetric contraction phase of cardiac cycle? A:All Valves are closed (AV valves & Semilunar Valves)‏

12. Q:Time for ventricular systole? A:0.3 Sec Q: Time for Ventricular Diastole? A: 0.5 Sec Q:Time for Cardiac Cycle? A: 0.8 Sec

13. DR. ZAHOOR ALI SHAIKH CARDIOVASCULAR SYSTEM LECTURE - VIII

14. HEART SOUNDS

15. There are four heart sounds SI, S2, S3 & S4. Two heart sound are audible with stethoscope S1 & S2 (Lub - Dub). S3 & S4 are not audible with stethoscope Under normal conditions because they are low frequency sounds. Ventricular Systole is between First and second Heart sound. Ventricular diastole is between Second and First heart sounds.

16. First heart sound (S1)‏ It is produced due to the closure of Atrioventricular valves (Mitral & Tricuspid)‏ It occurs at the beginning of the systole and sounds like LUB Frequency:50-60 Htz Time: 0.15 sec

17. Second heart sound (S2)‏ It is produced due to the closure of Semilunar valves (Aortic & Pulmonary)‏ It occurs at the end of the systole and sounds like DUB Frequency:80-90 Htz Time: 0.12 sec It is short and sharp

18. Third heart sound (S3)‏ It occurs at the beginning of middle third of Diastole Cause of third heart sound – Rush of blood from Atria to Ventricle during rapid filling phase of Cardiac Cycle. It causes vibration in the blood Frequency:20-30 Htz Time: 0.1 sec

19. Fourth heart sound (S4) or Atrial Sound It occurs at the last one third of Diastole (just before S1)‏ Cause of Fourth heart sound – Due to Atrial contraction which causes rapid flow of blood from Atria to Ventricle and vibration in the blood. Frequency: < 20 Htz Note: Third and Fourth heart sound are low pitched sounds therefore not audible normally with stethoscope S3 may be heard in children and young adults but usually pathological in old age

20. Heart valves - superior view

21. Function of papillary muscle & Chordae tendineae

26. The Events of the Cardiac Cycle

27. Heart Murmurs Murmurs are abnormal sounds produced due to abnormal flow of blood through abnormal heart valves eg.: stenosis or incompetence.

28. WHAT YOU SHOULD KNOW FROM THIS LECTURE? Functions of A-V vales & Semilunar valves. Functions of papillary muscles. There are four heart sounds : S 1, S 2, S 3, & S 4. Audible with stethoscope are only S 1 (Lub) & S 2 (Dub / Dup)‏ Use of stethoscope

29. Places to be auscultated on the chest for heart sounds i.e. Aortic, pulmonary, Mitral & tricuspid area. Position of the subject while auscultation. Recording of heart sound – Phonocardiogram. Relationship of heart sound with ECG. Splitting of second heart sound A 2 -P 2. Listening of S 3 & S 4 in physiological & pathological conditions Murmers (abnormal heart sounds).