1. CARDIOVASCULAR SYSTEM CARDIAC CYCLE-II HEART SOUNDS 1 DR. Mohammed Sharique Ahmed Quadri

2. Ventricular Systole 0.3 sec. Ventricular Diastole 0.5 sec. Ventricular Systole 0.3 sec. Isometric contraction phase Ejection phase Isometric Relaxation phase Rapid inflow phase Diastasis Atrial Systole Cardiac cycle time = 0.8 Sec. (if the heart rate is 75 beats/min.)

3. SystoleDiastoleSystole Phonocadiogra m Electrocardiogra m Ventricular volume Ventricular pressure 120 80 0 Cardiac cycle P Q R S T P Q R S T 1 st 2 nd 3 rd Aortic pressure

4. SystoleDiastoleSystole Atrial pressure ac v ac v

5. Events of cardiac cycle

6. Mitral valve closes Aortic valve opens Aortic valve closes Mitral valve opens

8. Relationship between Lt. ventricular volume & pressure changes 8

9. Pressure changes during cardiac cycle 9 Rt- Atrium = 0-7mm Hg. Lt- Atrium = 2-10 mm Hg. Rt – Ventricle = 25 / 6(2-8) mm Hg. Lt – ventricle = 120 / 8(2-10) mm Hg. Aorta = 120 / 80 mm Hg. Pul. Artery = 25 / 10 mm Hg.

10. Ejection fraction (EF) is the percentage of ventricular end diastolic volume (EDV) which is ejected with each stroke. EF = 10 SV (EDV – ESV) EDV X 100 75 120 X 100 = 62.5% Normal ejection fraction is about 60 – 65 %. Ejection fraction is good index of ventricular function.

11. HEART SOUNDS 11

12. 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. 12

13. 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 Hz Time: 0.15 sec 13

14. 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 Hz [ High pitch ] Time: 0.12 sec It is short and sharp 14

15. HEART SOUNDS Important Sounds are caused by vibrations set within the wall of the ventricles and major arteries during valve closure. Opening of the valve does not cause sound. 15

16. 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 16

17. 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 noncompliant 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 17

18. ADAS VSVD EVENTS 18 HEART SOUNDS 0.7 Sec. 0.1 sec. 0.3Sec.0.5 sec. 1 st Heart Sound 2 nd Heart Sound3 rd Heart Sound4 th Heart Sound AS – Atrial Systole; AD – Atrial Diastole ; VS – Ventricular systole; VD – Ventricular diastole

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20. Heart Murmurs Murmurs are abnormal sounds produced due to turbulent blood flow through abnormal heart valves e.g.. stenosis or incompetence. Stenosis means narrow or stiff, valve that does not open completely. Incompetent means valve which does not close properly and remains open. 20

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22. Heat Murmurs When blood is forced through stenotic valve, it produces an abnormal whistling sound. When blood flows backward through incompetent valve, it produces swishing or gurgling murmur sound. Most common cause of stenosis and incompetent valve is Rheumatic fever, an auto immune disease triggered by Streptococcus bacterial infection. 22

23. Heat Murmurs Systolic murmur are produced during the systole of the ventricle, between 1st and 2nd heart sound (Lub – Murmer – Dup). Diastolic murmur are produced during the diastole of the ventricle, between 2nd and 1st heart sound (Lub – Dup – Murmer – Lub). During aortic stenosis and mitral incompetence – systolic murmur. Aortic incompetence and Mitral Stenosis – diastolic murmur. 23

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25. THANK YOU 25