upgrade
upgrade

🫀Anatomy and Physiology II

Cardiac Cycle Phases

Study smarter with Fiveable

Get study guides, practice questions, and cheatsheets for all your subjects. Join 500,000+ students with a 96% pass rate.

Get Started

Why This Matters

The cardiac cycle is the rhythmic sequence of contractions and relaxations that keeps blood flowing through your body every second of your life. You're being tested on more than just "the heart pumps blood"—exams focus on pressure-volume relationships, valve mechanics, and the precise timing that makes the heart an efficient pump. Understanding why valves open and close when they do, and how pressure gradients drive blood flow, connects directly to concepts like Starling's Law, cardiac output, and clinical conditions like heart murmurs.

Think of the cardiac cycle as a pressure story: blood always moves from high pressure to low pressure, and valves are passive gates that respond to these pressure differences. When you study these phases, focus on what's happening to pressure, which valves are open or closed, and whether volume is changing. Don't just memorize phase names—know what mechanical principle each phase demonstrates and how it contributes to efficient circulation.


Systolic Phases: When the Heart Contracts

Systole refers to contraction—the active, energy-requiring phase where the myocardium generates force. The key principle here is that contraction increases pressure, and pressure gradients determine valve behavior and blood movement.

Atrial Systole

  • Completes ventricular filling—the atria contract to "top off" the ventricles, contributing approximately 20-30% of total ventricular volume
  • AV valves are open during this phase because atrial pressure exceeds ventricular pressure, allowing blood to flow downward
  • Often called the "atrial kick"—this contribution becomes critical during exercise or in patients with heart failure when passive filling isn't sufficient

Isovolumetric Contraction

  • All four valves are closed—ventricular pressure is rising but hasn't yet exceeded arterial pressure, so semilunar valves remain shut
  • Volume stays constant while pressure increases dramatically; this is pure pressure-building with no blood movement
  • Marks the beginning of ventricular systole—the first heart sound (S1, "lub") occurs here as AV valves snap shut

Rapid Ejection

  • Semilunar valves open when ventricular pressure exceeds pressure in the aorta and pulmonary artery
  • Maximum blood flow rate—approximately two-thirds of stroke volume is ejected during this brief, powerful phase
  • Ventricular volume drops steeply as blood rushes into the great arteries; this is the heart doing its primary job

Reduced Ejection

  • Ejection continues but slows as the pressure gradient between ventricles and arteries decreases
  • Myocardial contraction is waning—the ventricles are running out of contractile force
  • Prepares for valve closure—as ventricular pressure falls below arterial pressure, semilunar valves will close

Compare: Isovolumetric Contraction vs. Rapid Ejection—both occur during ventricular systole, but isovolumetric contraction builds pressure with all valves closed, while rapid ejection moves blood with semilunar valves open. If asked about pressure-volume loops, isovolumetric contraction is the vertical rise on the left side.


Diastolic Phases: When the Heart Relaxes

Diastole is relaxation—the passive phase where chambers refill. The principle here is that relaxation decreases pressure, creating gradients that pull blood into the chambers without requiring energy.

Atrial Diastole

  • Atria passively fill with blood returning from the pulmonary veins (left atrium) and venae cavae (right atrium)
  • AV valves are closed during most of ventricular systole, so blood accumulates in the atria
  • Atrial pressure gradually rises as blood pools, preparing for the pressure gradient that will open AV valves

Isovolumetric Relaxation

  • All four valves are closed—ventricular pressure is falling but hasn't dropped below atrial pressure yet
  • Volume remains constant while pressure plummets; this is the mirror image of isovolumetric contraction
  • Second heart sound (S2, "dub") occurs here as semilunar valves snap shut, preventing arterial backflow

Rapid Ventricular Filling

  • AV valves open when ventricular pressure drops below atrial pressure, and blood rushes in
  • Accounts for ~70-80% of ventricular filling—most filling is passive, driven by the pressure gradient alone
  • Third heart sound (S3) may occur in this phase; normal in young adults but pathological in older patients

Reduced Ventricular Filling

  • Filling rate slows as the pressure gradient between atria and ventricles equalizes
  • Diastasis period—a brief pause where little blood movement occurs before atrial systole begins
  • Sets the stage for atrial contraction—the heart is nearly ready to begin the next cycle

Compare: Isovolumetric Relaxation vs. Isovolumetric Contraction—both have all valves closed and constant volume, but relaxation drops pressure (beginning diastole) while contraction raises pressure (beginning systole). FRQs love asking about these "isovolumetric" phases because they test your understanding of valve mechanics.


Pressure-Volume Relationships: The Mechanical Story

Understanding how pressure and volume change together reveals why the cardiac cycle works. These relationships are often tested through pressure-volume loops and Wiggers diagrams.

Ventricular Systole (Overall)

  • Divided into isovolumetric contraction and ejection phases—first pressure builds, then blood moves
  • AV valves close at the start (creating S1) when ventricular pressure exceeds atrial pressure
  • End-systolic volume (ESV) is the blood remaining in ventricles after ejection; a key variable in calculating ejection fraction

Ventricular Diastole (Overall)

  • Divided into isovolumetric relaxation and filling phases—first pressure drops, then blood enters
  • Semilunar valves close at the start (creating S2) when arterial pressure exceeds ventricular pressure
  • End-diastolic volume (EDV) is the blood in ventricles after filling; increased EDV increases stroke volume via Starling's Law

Compare: Ventricular Systole vs. Ventricular Diastole—systole is shorter (~0.3 sec) and active, while diastole is longer (~0.5 sec) and passive. At higher heart rates, diastole shortens more than systole, which can compromise filling time and cardiac output.


Quick Reference Table

ConceptBest Examples
Valves closed, volume constantIsovolumetric Contraction, Isovolumetric Relaxation
AV valves openAtrial Systole, Rapid Ventricular Filling, Reduced Ventricular Filling
Semilunar valves openRapid Ejection, Reduced Ejection
Pressure buildingIsovolumetric Contraction, Atrial Diastole
Pressure fallingIsovolumetric Relaxation, Reduced Ejection
Active contractionAtrial Systole, Ventricular Systole
Passive fillingRapid Ventricular Filling, Reduced Ventricular Filling
Heart soundsS1 (Isovolumetric Contraction), S2 (Isovolumetric Relaxation)

Self-Check Questions

  1. Which two phases share the characteristic of having all four heart valves closed simultaneously, and what distinguishes them from each other?

  2. If a patient has a heart murmur heard during ventricular systole, which valves might be malfunctioning, and during which specific phases would you expect to hear it?

  3. Compare and contrast rapid ventricular filling with atrial systole—how do their contributions to ventricular filling differ, and why does the "atrial kick" become more important during tachycardia?

  4. On a pressure-volume loop, which phases correspond to the vertical segments (where volume doesn't change), and what is happening to pressure during each?

  5. Why does the second heart sound (S2) occur at the beginning of isovolumetric relaxation rather than at the end of reduced ejection? What pressure relationship triggers semilunar valve closure?