Hemodynamic Cycle

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    Hemodynamic cycle, heart sounds,

    valvular heart disorders

    Physiology and Pathophysiology of the heart

    Part 1

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    Phase 1

     Atrial Contraction

    RV

    LV

    LA

    PA RA

     A

    RV

    LV

    LA

    PA RA

     A

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

     

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    Phase 2

    Isovolumetric

    Contraction

    RV

    LV

    LA

    PA RA

     A

     P  

    P   120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

    Phase 2

    Isovolumetric

    Contraction

    RV

    LV

    LA

    PA RA

     A

     P  

    P

    RV

    LV

    LA

    PA RA

     A

     P  

    P   120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

     

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    Phase 3

    Rapid Ejection

    RV

    LV

    LA

    PA RA

     A

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press

    (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

    Phase 3

    Rapid Ejection

    RV

    LV

    LA

    PA RA

     A

    RV

    LV

    LA

    PA RA

     A

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press

    (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press

    (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

     

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    RV

    LV

    LA

    PA RA

     A

    Phase 4

    Reduced Ejection

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

    RV

    LV

    LA

    PA RA

     A

    Phase 4

    Reduced Ejection

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

     

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    RV

    LV

    LA

    PA RA

     A

    Phase 5

    Isovolumetric

    Relaxation

     

    P  P   120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

    RV

    LV

    LA

    PA RA

     A

    Phase 5

    Isovolumetric

    Relaxation

     

    P  P   120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

     

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    RV

    LV

    LA

    PA RA

     A

    Phase 6

    Rapid Filling

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

    Time (sec)

    RV

    LV

    LA

    PA RA

     A

    Phase 6

    Rapid Filling

    120

    40

    80

    0

    40

    80

    120

    LV

    Vol

    (ml)

    Press (mmHg)

    1 2 3 4 5   6   7

    Phase

    0 0.4 0.8

    Time (sec)

    Heart

    Sounds

    ECG

    LV Press

    Aortic Pressure

    LA Press

    LVEDV

    LVESV

    I   II IIIIV

    a   c v

     

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    HR 75/MIN HR 200/MIN Skeletal muscle

    Hemodynamic cycle duration 0,80 0,30

    Systole 0,27 0,16

    Action potential duration 0,25 0,15 0,005

    Absolute refraction period 0,20 0,13 0,004

    Relative refraction period 0,05 0,02 0,003

    Diastole 0,53 0,14

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    Heart sounds

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    Heart sounds Sound Appears during Results from:

    S1 Isovolumetric contraction

    Caused by the sudden block of reverse blood flow due to closure of the atrioventricular valves

    S2 Isovolumetric relaxation

    Caused by the sudden block of reversing blood flow due to closure of the semilunar valves

    S3 Rapid ventricle filling

    Physiology (benign) in children, also trained individual and sometimes in pregnancy; protodiastolic gallop, ventricular gallop

    Pathology –

     failing left ventricle (dilated ventricle)

    S4 Atrial systole Low plasticity of the ventricles (ex. Hypetrophy) presystolic gallop or atrial gallop

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    Heart sounds -

    murmurs

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    Cardiac Output = Heart Rate (HR) x Stroke Volume (SV)

    •  HR regulation

    • SV regulation

    Cardiac output

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    HR regulation

    www.cvphysiology.com

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    ANS and regulation of the heart work

    Muscarinic M2 rec

    activation

    SA

    AV

    Vagal nerve Sympathetic system

    ACh NE

    HR

    Inotropy

    +  

     – 

    Adrenergic β1 rec

    activation

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    β  Gs cAMP

    β 

    Gs cAMP

    NA

    NA

    Na+  Na+ 

    Na+ 

    Na+ 

    Na+ 

    Na+ 

    Na+  Na+  Na+ 

    Na+ 

    Na+ 

    Na+ 

    Na+ 

    Na+ 

    Na+ 

    Ca2+ 

    Ca2+ 

    Ca2+ 

    Ca2+