Mechanical and Electrical Events of the Cardiac Cycle

Cardiac Cycle
Cardiac Cycle: the electrical, pressure and volume changes that occur in a functional heart between successive heart beats. Phase of the cardiac cycle when myocardium is relaxed is termed diastole. Phase of the cardiac cycle when the myocardium contracts is termed systole.
Atrial systole: when atria contract. Ventricular systole: when ventricles contract.

Mechanical Events of the Cardiac Cycle

1. Ventricular Filling Period [ventricular diastole, atrial systole] 2. Isovolumetric Contraction Period [ventricular systole] 3. Ventricular Ejection Period [ventricular systole] 4. Isovolumetric Relaxation Period [ventricular diastole]

Cardiac Cycle
Electrical changes in heart tissue cause mechanical, i.e. muscle contraction, changes. Thus, changes in electrical membrane potential of specific parts of the heart tissue represent mechanical events in specific areas of the heart tissue.

Electrical Events of the Cardiac Cycle

Each wave or interval represents depolarization or repolarization of myocardial tissue. P wave represents depolarization of atria which causes atrial contraction. QRS complex reflects depolarization of ventricles which causes contraction. T wave reflects repolarization of muscle fibers in ventricles.

The impulse travels very slowly through the AV node, then very quickly through the bundle of His, then the bundle branches, the Purkinje network, and finally the ventricular muscle.

1. The electrical activity of the heart originates in the sino-atrial node. The impulse then rapidly spreads through the right atrium to the atrioventricular node. It also spreads through the atrial muscle directly from the right atrium to the left atrium. The P-wave is generated by activation of the muscle of both atria.

2. The first area of the ventricular muscle to be activated is the interventricular septum, which activates from left to right. This generates the Q-wave. 3. Next, the left and right ventricular free walls, which form the bulk of the muscle of both ventricles, gets activated, with the endocardial surface being activated before the epicardial surface. This generates the R-wave.

4. A few small areas of the ventricles are activated at a rather late stage. This generates the S-wave.

5. Finally, the ventricular muscle repolarizes. This generates the T-wave.

Cardiac Cycle
Coordination of : Electrical Changes Pressure Changes in Left Atria, Left Ventricle and Aorta Ventricular Volume Changes Cardiac Valves

Electrocardiography
Two common abbreviations for electrocardiogram: EKG and ECG. EKG comes from German language where cardiogram is written as kardiogram. The ECG records the electrical activity of the heart. Mechanical activity of the heart is sensed by echocardiography.

Electrocardiography
ECG - electrocardiogram graphic recording of electrical events established electrode pattern results in specific tracing pattern electrical pattern reveals blood supply problems

Electrophysiology
If an electrode is placed so that wave of depolarization spreads toward the recording electrode, the ECG records a positive (upward) deflection. If wave of depolarization spreads away from recording electrode, a negative (downward) deflection occurs.

Electrophysiology

Cardiac Current Flow

Cardiac Current Flow

ECG Time & Voltage

ECG machines can run at 50 or 25 mm/sec. Major grid lines are 5 mm apart, at standard 25 mm/s, 5 mm corresponds to .20 seconds. Minor lines are 1 mm apart, at standard 25 mm/s, 1 mm corresponds to .04 seconds. Voltage is measured on vertical axis. Standard calibration is 0.1 mV per mm of deflection.

Electrophysiology
When myocardial muscle is completely polarized or depolarized, the ECG will not record any electrical potential but rather a flat line, isoelectric line. After depolarization, myocardial cells undergo repolarization to return to electrical state at rest.

Electrophysiology
P wave represents depolarization of atria which causes atrial contraction Repolarization of atria not normally detectable on an ECG Excitation of bundle of His and bundle branches occur in middle of PR interval QRS complex reflects depolarization of ventricles T wave reflects repolarization of muscle fibers in ventricles

Electrocardiogram
Normal P wave has amplitude of 0.25 mV Q wave is first downward deflection after P wave; signals start of ventricular depolarization R wave is positive deflection after Q wave S wave is negative deflection preceded by Q or R waves T wave follows QRS

Standard 12-Lead ECG

Usually performed when person is resting in supine position. Composed of three bipolar limb leads: I, II, and III; three augmented voltage leads: aVR, aVL, aVF; and six chest or precordial leads: V1 V6. All limb leads lie in frontal plane. Chest leads circle heart in transverse plane.

ECG Limb Leads

ECG Augmented Limb Leads

ECG Precordial Leads

Standard 12-Lead ECG

Each lead provides a different electrical angle or picture of the heart. Anterior part of heart by looking at V1 V4. Lateral view of heart: I, aVL, V5 and V6. Inferior view of heart: II, III, and aVF.

Exercise 12-Lead ECG

12-Lead ECG
Limb lead II shows large QRS amplitude because left ventricle vector lies parallel with electrode placement. Chest lead V1 has large S wave because left ventricle current vector is directed away from electrode.

12-Lead ECG Strip

Interpretation of ECG
Rate. First measurement to calculate is heart rate. PQRST waves represent one complete cardiac cycle. At standard paper speed, divide 1500 by distance between R to R waves. Find R wave on heavy line. Count off 300, 150, 100, 75, 60 for each following line. Where next R lands is quick estimate. Multiply number of cycles in 6 second marks by 10.

Interpretation of ECG

Interpretation of ECG
Normal heart rhythm has consistent R-R interval. Mild variations due to breathing also normal.

Interpretation of ECG
Normal Sinus Rhythm Rate: 60-100 b/min Rhythm: regular P waves: upright in leads I, II, aVF PR interval: < .20 s QRS: < .10 s

Interpretation of ECG

ST segment depression. Hallmark of myocardial ischemia. Reduction of oxygen-rich blood supply alters normal cellular action causing ST segment displacement 1 mm below line. Upsloping, horizontal, downsloping