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The cardiac cycle is the performance of the human heart from the beginning of one heartbeat to the beginning of the next. It consists of two periods: one during which the heart muscle relaxes and refills with blood, called diastole, following a period of robust contraction and pumping of blood, called systole. After emptying, the heart immediately relaxes and expands to receive another influx of blood returning from the lungs and other systems of the body, before again contracting to pump blood to the lungs and those systems. A normally performing heart must be fully expanded before it can efficiently pump again. Assuming a healthy heart and a typical rate of 70 to 75 beats per minute, each cardiac cycle, or heartbeat, takes about 0.8 second to complete the cycle. There are two
atrial The atrium ( la, ātrium, , entry hall) is one of two upper chambers in the heart that receives blood from the circulatory system. The blood in the atria is pumped into the heart ventricles through the atrioventricular valves. There are two at ...
and two ventricle chambers of the heart; they are paired as the
left heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to ...
and the
right heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxid ...
—that is, the left atrium with the left ventricle, the right atrium with the right ventricle—and they work in concert to repeat the cardiac cycle continuously, (see cycle diagram at right margin). At the start of the cycle, during ''ventricular diastole''–early, the heart relaxes and expands while receiving blood into both ventricles through both atria; then, near the end of ''ventricular diastole''–late, the two atria begin to contract ( ''atrial systole''), and each atrium pumps blood into the ventricle below it. During ''ventricular systole'' the ventricles are contracting and vigorously pulsing (or ejecting) two separated blood supplies from the heart—one to the lungs and one to all other body organs and systems—while the two atria are relaxed ( ''atrial diastole''). This precise coordination ensures that blood is efficiently collected and circulated throughout the body. The
mitral The mitral valve (), also known as the bicuspid valve or left atrioventricular valve, is one of the four heart valves. It has two cusps or flaps and lies between the left atrium and the left ventricle of the heart. The heart valves are all one-w ...
and
tricuspid The tricuspid valve, or right atrioventricular valve, is on the right dorsal side of the mammalian heart, at the superior portion of the right ventricle. The function of the valve is to allow blood to flow from the right atrium to the right vent ...
valves, also known as the atrioventricular, or AV valves, open during ventricular diastole to permit filling. Late in the filling period the atria begin to contract (atrial systole) forcing a final crop of blood into the ventricles under pressure—see cycle diagram. Then, prompted by electrical signals from the
sinoatrial node The sinoatrial node (also known as the sinuatrial node, SA node or sinus node) is an oval shaped region of special cardiac muscle in the upper back wall of the right atrium made up of cells known as pacemaker cells. The sinus node is approximat ...
, the ventricles start contracting (ventricular systole), and as back-pressure against them increases the AV valves are forced to close, which stops the blood volumes in the ventricles from flowing in or out; this is known as the ''isovolumic contraction'' stage. Due to the contractions of the systole, pressures in the ventricles rise quickly, exceeding the pressures in the trunks of the
aorta The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes ...
and the
pulmonary The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...
arteries and causing the requisite valves (the
aortic The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes ox ...
and
pulmonary The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...
valves) to open—which results in separated blood volumes being ejected from the two ventricles. This is the ejection stage of the cardiac cycle; it is depicted (see circular diagram) as the ''ventricular systole–first phase'' followed by the ''ventricular systole–second phase''. After ventricular pressures fall below their peak(s) and below those in the trunks of the aorta and pulmonary arteries, the aortic and pulmonary valves close again—see, at the right margin,
Wiggers diagram A Wiggers diagram, named after its developer, Carl Wiggers, is a unique diagram that has been used in teaching cardiac physiology for more than a century. In the Wiggers diagram, the X-axis is used to plot time subdivided into the cardiac phase ...
, blue-line tracing. Now follows the ''isovolumic relaxation'', during which pressure within the ventricles begin to fall significantly, and thereafter the atria begin refilling as blood returns to flow into the right atrium (from the
vena cavae In anatomy, the venae cavae (; singular: vena cava ; ) are two large veins (great vessels) that return deoxygenated blood from the body into the heart. In humans they are the superior vena cava and the inferior vena cava, and both empty into th ...
) and into the left atrium (from the pulmonary veins). As the ventricles begin to relax, the mitral and tricuspid valves open again, and the completed cycle returns to ventricular diastole and a new "Start" of the cardiac cycle. Throughout the cardiac cycle, blood pressure increases and decreases. The movements of
cardiac muscle Cardiac muscle (also called heart muscle, myocardium, cardiomyocytes and cardiac myocytes) is one of three types of vertebrate muscle tissues, with the other two being skeletal muscle and smooth muscle. It is an involuntary, striated muscle that ...
are coordinated by a series of electrical impulses produced by specialised
pacemaker cells 350px, Image showing the cardiac pacemaker or SA node, the primary pacemaker within the electrical_conduction_system_of_the_heart">SA_node,_the_primary_pacemaker_within_the_electrical_conduction_system_of_the_heart. The_muscle_contraction.htm ...
found within the
sinoatrial node The sinoatrial node (also known as the sinuatrial node, SA node or sinus node) is an oval shaped region of special cardiac muscle in the upper back wall of the right atrium made up of cells known as pacemaker cells. The sinus node is approximat ...
and the
atrioventricular node The atrioventricular node or AV node electrically connects the heart's atria and ventricles to coordinate beating in the top of the heart; it is part of the electrical conduction system of the heart. The AV node lies at the lower back section of t ...
. Cardiac muscle is composed of
myocytes A muscle cell is also known as a myocyte when referring to either a cardiac muscle cell (cardiomyocyte), or a smooth muscle cell as these are both small cells. A skeletal muscle cell is long and threadlike with many nuclei and is called a musc ...
which initiate their internal contractions without applying to external nerves—with the exception of changes in the heart rate due to metabolic demand. In an electrocardiogram, electrical systole initiates the atrial systole at the P wave deflection of a steady signal; and it starts contractions (systole).


The cardiac cycle and Wiggers diagram

The cardiac cycle involves four major stages of activity: 1) "Isovolumic relaxation", 2) Inflow, 3) "Isovolumic contraction", 4) "Ejection". (See Wiggers diagram, which presents the stages, label-wise, in 3,4,1,2 order, left-to-right.) Moving from the left along the Wiggers diagram shows the activities within four stages during a single cardiac cycle. (See the consecutive panels labeled, at bottom-right, "Diastole" then "Systole"). Stages 1 and 2 together—"Isovolumic relaxation" plus Inflow (equals "Rapid inflow", "Diastasis", and "Atrial systole")—comprise the ventricular "Diastole" period, including atrial systole, during which blood returning to the heart flows through the atria ''into'' the relaxed ventricles. Stages 3 and 4 together—"Isovolumic contraction" plus "Ejection"—are the ventricular "Systole" period, which is the simultaneous pumping of separate blood supplies ''from'' the two ventricles, one to the pulmonary artery and one to the aorta. Notably, near the end of the "Diastole", the atria begin contracting, then pumping blood into the ventricles; this pressurized delivery during ventricular relaxation (ventricular diastole) is called the ''atrial systole'', aka ''atrial kick''. The time-wise increases and decreases of the heart's blood volume (see Wiggers diagram), are also instructive to follow. The red-line tracing of "Ventricular volume" provides an excellent track of the two periods and four stages of one cardiac cycle. Starting with the Diastole period: the low-volume plateau of "Isovolumic relaxation" stage, followed by a rapid rise and two slower rises, all components of the "Inflow stage"—increasing to the high-volume plateau of the "Isovolumic contraction" stage; (find the label at left side of diagram). Then, the Systole, including the high "Isovolumic contraction" stage to the rapid decrease in blood volume (i.e., the vertical drop of the red-line tracing) which signifies the emptying of the ventricles during the "Ejection" stage of the completed cycle—all equal to one heartbeat.


Stages

Valve configurations during main stages of the cardiac cycle+ Notes: Stages 1, 2a, and 2b together comprise the "Diastole" period; stages 3 and 4 together comprise the "Systole" period. + based on Ganong Barrett, et al. ''Ganong's Review of Medical Physiology'' 24e (2012) Table 30-3 # Rapid-filling inflow produced by atrial systole during "ventricular diastole–late" * Atrioventricular (AV) valves= tricuspid valve; mitral valve Semilunar valves= pulmonary valve; aortic valve Dicrotic notch- rebounding of the aorta, helps perfuse coronary arteries, with increasing age the aorta stiffens and less elasticity hence the notch may be less and problems arise perfusing coronary arteries


Physiology

The
heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to ...
is a four-chambered organ consisting of right and left halves, called the
right heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxid ...
and the
left heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to ...
. The upper two chambers, the left and right atria, are entry points ''into'' the heart for blood-flow returning from the circulatory system, while the two lower chambers, the left and right ventricles, perform the contractions that eject the blood ''from'' the heart to flow through the circulatory system. Circulation is split into
pulmonary circulation The pulmonary circulation is a division of the circulatory system in all vertebrates. The circuit begins with deoxygenated blood returned from the body to the right atrium of the heart where it is pumped out from the right ventricle to the lungs. ...
—during which the right ventricle pumps oxygen-depleted blood to the lungs through the
pulmonary trunk A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the right side of the heart to the lungs. The largest pulmonary artery is the ''main pulmonary artery'' or ''pulmonary trunk'' from the heart, and ...
and arteries; or the
systemic circulation The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
—in which the left ventricle pumps/ejects newly oxygenated blood throughout the body via the
aorta The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes ...
and all other arteries.


Heart electrical conduction system

In a healthy heart all activities and rests during each individual cardiac cycle, or heartbeat, are initiated and orchestrated by signals of the heart's electrical conduction system, which is the "wiring" of the heart that carries electrical impulses throughout the body of
cardiomyocyte Cardiac muscle (also called heart muscle, myocardium, cardiomyocytes and cardiac myocytes) is one of three types of vertebrate muscle tissues, with the other two being skeletal muscle and smooth muscle. It is an involuntary, striated muscle that ...
s, the specialized muscle cells of the heart. These impulses ultimately stimulate heart muscle to contract and thereby to eject blood from the ventricles into the arteries and the cardiac circulatory system; and they provide a system of intricately timed and persistent signaling that controls the rhythmic beating of the heart muscle cells, especially the complex impulse-generation and muscle contractions in the atrial chambers. The rhythmic sequence (or
sinus rhythm A sinus rhythm is any cardiac rhythm in which depolarisation of the cardiac muscle begins at the sinus node. It is characterised by the presence of correctly oriented P waves on the electrocardiogram (ECG). Sinus rhythm is necessary, but not s ...
) of this signaling across the heart is coordinated by two groups of specialized cells, the
sinoatrial The sinoatrial node (also known as the sinuatrial node, SA node or sinus node) is an oval shaped region of special cardiac muscle in the upper back wall of the right atrium made up of cells known as pacemaker cells. The sinus node is approxim ...
(SA) node, which is situated in the upper wall of the right atrium, and the atrioventricular (AV) node located in the lower wall of the
right heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxid ...
between the atrium and ventricle. The sinoatrial node, often known as the ''
cardiac pacemaker 350px, Image showing the cardiac pacemaker or SA node, the primary pacemaker within the electrical_conduction_system_of_the_heart">SA_node,_the_primary_pacemaker_within_the_electrical_conduction_system_of_the_heart. The_muscle_contraction.ht ...
'', is the point of origin for producing a wave of electrical impulses that stimulates atrial contraction by creating an
action potential An action potential occurs when the membrane potential of a specific cell location rapidly rises and falls. This depolarization then causes adjacent locations to similarly depolarize. Action potentials occur in several types of animal cells, ...
across myocardium cells. Impulses of the wave are delayed upon reaching the AV node, which acts as a gate to slow and to coordinate the electrical current before it is conducted below the atria and through the circuits known as the
bundle of His The bundle of His (BH) or His bundle (HB) ( "hiss"Medical Terminology for Health Professions, Spiral bound Version'. Cengage Learning; 2016. . pp. 129–.) is a collection of heart muscle cells specialized for electrical conduction. As part of t ...
and the Purkinje fibers—all which stimulate contractions of both ventricles. The programmed delay at the AV node also provides time for blood volume to flow through the atria and fill the ventricular chambers—just before the return of the systole (contractions), ejecting the new blood volume and completing the cardiac cycle. (See Wiggers diagram: "Ventricular volume" tracing (red), at "Systole" panel.)


Diastole and systole in the cardiac cycle

Cardiac diastole is the period of the cardiac cycle when, after contraction, the heart relaxes and expands while refilling with blood returning from the circulatory system. Both atrioventricular (AV) valves open to facilitate the 'unpressurized' flow of blood directly through the atria into both ventricles, where it is collected for the next contraction. This period is best viewed at the middle of the Wiggers diagram—see the panel labeled "Diastole". Here it shows pressure levels in both atria and ventricles as near-zero during most of the diastole. (See gray and light-blue tracings labeled "Atrial pressure" and "Ventricular pressure"—Wiggers diagram.) Here also may be seen the red-line tracing of "Ventricular volume", showing increase in blood volume from the low plateau of the "Isovolumic relaxation" stage to the maximum volume occurring in the "Atrial systole" sub-stage.


Atrial systole

Atrial systole is the contracting of
cardiac muscle Cardiac muscle (also called heart muscle, myocardium, cardiomyocytes and cardiac myocytes) is one of three types of vertebrate muscle tissues, with the other two being skeletal muscle and smooth muscle. It is an involuntary, striated muscle that ...
cells of both atria following electrical stimulation and conduction of electrical currents across the atrial chambers (see above, ''Physiology''). While nominally a component of the heart's sequence of systolic contraction and ejection, atrial systole actually performs the vital role of completing the diastole, which is to finalize the filling of both ventricles with blood while they are relaxed and expanded for that purpose. Atrial systole overlaps the end of the diastole, occurring in the sub-period known as ''ventricular diastole–late'' (see cycle diagram). At this point, the atrial systole applies contraction pressure to 'topping-off' the blood volumes sent to both ventricles; this ''atrial kick'' closes the diastole immediately before the heart again begins contracting and ejecting blood ''from'' the ventricles (ventricular systole) to the aorta and arteries. Atrial kick is absent or disrupted if there is loss of normal electrical conduction in the heart, such as caused by atrial fibrillation,
atrial flutter Atrial flutter (AFL) is a common abnormal heart rhythm that starts in the atrial chambers of the heart. When it first occurs, it is usually associated with a fast heart rate and is classified as a type of supraventricular tachycardia. Atrial ...
, or
heart block Heart block (HB) is a disorder in the heart's rhythm due to a fault in the natural pacemaker. This is caused by an obstruction – a block – in the electrical conduction system of the heart. Sometimes a disorder can be inherited. Despite the se ...
. Atrial kick may also be degraded by any deterioration in the condition of the heart, such as "stiff heart" found in patients with diastolic dysfunction.


Ventricular systole

Ventricular systole is the contractions, following electrical stimulations, of the ventricular syncytium of cardiac muscle cells in the left and right ventricles. Contractions in the right ventricle provide
pulmonary circulation The pulmonary circulation is a division of the circulatory system in all vertebrates. The circuit begins with deoxygenated blood returned from the body to the right atrium of the heart where it is pumped out from the right ventricle to the lungs. ...
by pulsing oxygen-depleted blood through the pulmonary valve then through the pulmonary arteries to the lungs. Simultaneously, contractions of the left ventricular systole provide
systemic circulation The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
of oxygenated blood to all body systems by pumping blood through the aortic valve, the aorta, and all the arteries. (Blood pressure is routinely measured in the larger arteries off the left ventricle during the left ventricular systole).


See also

*
Apex beat The apex is the highest point of something. The word may also refer to: Arts and media Fictional entities * Apex (comics), a teenaged super villainess in the Marvel Universe * Ape-X, a super-intelligent ape in the Squadron Supreme universe *Ape ...
*
Cardiac action potential The cardiac action potential is a brief change in voltage (membrane potential) across the cell membrane of heart cells. This is caused by the movement of charged atoms (called ions) between the inside and outside of the cell, through proteins ca ...
*
Cardiac output In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: t ...
* Pulse


References


Bibliography

*


External links


Interactive cardiac cycle
''Interactivephysiology.com'' {{Cardiovascular physiology Cardiovascular physiology