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cardiac cycle,heart sounds and ECG
The cardiac cycle consists of rhythmic changes that occur with each heartbeat. It has several phases including isovolumic contraction, ejection, isovolumic relaxation, and atrial systole. Heart sounds are produced by the closing of valves and include S1, S2, S3, S4, and murmurs. An electrocardiogram (ECG) records the electrical activity of the heart through electrodes on the skin and analyzes waves, intervals, and other characteristics to evaluate heart rate and identify conditions like coronary artery disease.
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cardiac cycle,heart sounds and ECG
- 1. Cardiac Cycle, HeartSounds and Electrocardiography Velvizhi G (world’s best sister !!)
- 2.
- 3. What is theCardiac Cycle? 72 beats per minute 60 mins per hour 24 hours per day 365 days per year 72 x 60 x 24 x 365 x 70 = more than 2.5 x 109 An average person's heart beats more than 2 billion times in a lifetime of 70 yrs Rhythmic changes that happen with each beat are called the cardiac cycle
- 4. Cardiac Anatomy inbrief Two atria and two ventricles Ventricles – main pumping chamber Atria – reservoir / booster pump Atrioventricular valves – allow flow from atrium to ventricle only Semilunar valves – allows flow from ventricle to great artery only
- 5. Rhythm generation and conduction Sinoatrialnode – pacemaker of the heart Atrioventricular node – conducts impulse from atrium to ventricle Delay at AV node allows time for filling of ventricles
- 6. Cardiac Cycle -Components
- 7. Isovolumic contraction First phaseof ventricular systole Ventricular pressure ++ Ventricular volume = Begins with first heart sound
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- 9. Protodiastole Sometimes named asa separate phase Continuing ejection before closure of the semilunar valves
- 10. Isovolumic relaxation Ventricular pressure-- Ventricular volume =
- 11. Rapid filling Ventricular pressure= Ventricular volume ++
- 12. Slow filling (diastasis) Ventricularpressure = Ventricular volume +
- 13. Atrial systole Ventricular pressure= Ventricular volume +
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- 16. Heart sounds Sounds producedby the beating heart Turbulent blood flow when valves close Usually listened with a stethoscope Very useful for physician to identify cardiac abnormalities
- 17. Heart Sounds First heartsound (S1) Second heart sound (S2) Third heart sound (S3) Fourth heart sound (S4) Murmurs
- 18. First heart sound Producedby closure of atrioventricular valves at beginning of systole Mitral (M1) and tricuspid (T1) valve closures very close together – so usually not appreciated separately
- 19. First heart sound Soft Rheumaticfever Heart failure Loud Mitral stenosis Anemia Pregnancy Variable intensity Complete heart block Atrial fibrillation
- 20. Second heart sound Producedby closure of the semilunar valves at the end of systole Closure of the aortic valve (A2) occurs before closure of the pulmonary valve (P2) A2-P2 can be heard as a split and this is wider during inspiration
- 21. Second heart sound Widesplit Pulmonary stenosis Pulmonary hypertension Right bundle branch block Wide and fixed split Atrial septal defect Reversed split (paradoxical split) Severe aortic stenosis Hypertrophic cardiomyopathy Loud P2 Pumonary hypertension
- 22. Third heart sound Lowfrequency sound in early diastole Due to rapid filling of the ventricles S3 May be normal (physiologic) Ventricular dysfunction Pregnancy, anemia Left to right shunts
- 23. Fourth heart sound Lowfrequency sound in late diastole Due to filling during atrial systole S4 May be normal in older individuals LV S4 – aortic stenosis, systemic hypertension, coronary artery disease RV S4 – pulmonary stenosis, pulmonary hypertension
- 24. Murmurs A series ofvibrations arising from the turbulent flow of blood across valves or other openings Systolic – after S1 and before S2 Diastolic – after S2 and before S1
- 25. Murmurs Systolic murmurs Normal (innocentmurmur) Ejection across semilunar valves - pulmonary stenosis, aortic stenosis Regurgitation (leak) across atrioventricular valves – mitral regurgitation, tricuspid regurgitation Ventricular septal defect Diastolic murmurs Always abnormal Aortic or pulmonary regurgitation Mitral or aortic stenosis
- 26. Murmurs due tovalve disease Systolic Diastolic
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- 28. ECG Electrical field generatedby heart that is recorded on body surface Three bipolar limb leads (I, II, III) Three unipolar limb leads (aVR, aVL and aVF) Six unipolar precordial leads (V1 – V6)
- 29. ECG – wavesand intervals
- 30. Heart rate Can becalculated by measuring interval between two beats (small square = 0.04 seconds, large square = 0.2 seconds) Shortcut – 300 divided by number of large squares between two beats Normal adult rate between 60 and 100 bpm
- 31. P wave Atrial depolarization TallP wave – Right atrial enlargement Broad P wave – Left atrial enlargement
- 32. QRS complex Ventricular depolarization BroadQRS Bundle branch blocks Ectopic rhythms (Ventricular tachycardia, ventricular pacing)
- 33. T wave Ventricular repolarization TallT waves – Hyperkalemia T inversion – Coronary artery disease
- 34. PR interval AV conduction ProlongedPR interval – First degree AV block Short PR interval - Preexcitation
- 35. QT interval Ventricular repolarization ProlongedQT interval Congenital long QT syndrome Acquired long QT - drugs
- 36. ECG in coronaryartery disease Most important clinical use of ECG ST segment shifts identify ischemia and infarction Q waves indicate old infarction
- 37. ECG in coronaryartery disease