• isovolumetric ventricle contraction
• rapid ventricular ejection
• reduced ventricular ejection

• isovolumetric ventricle relaxation
• rapid ventricular filling
• reduced ventricular filling
• diastasis or late diastole
• atrial contraction

1. SA node fires and excitation spread through atria
2. cause contraction
3. lead to regurgitation into veins (no valves between atria and veins)
4. at the end of this event, ventricles contain EDV

1. excitation spread (no back propagation due to fibrous ring) 
2. pressure inside rises, leading to AV valve closure (first heart sound)
3. for short time, semilunar and AV valves close, leading to rapid rise in intraventricular pressure
4. this pressure increase cause AV valve to buldge into atria, leading to increase in atrial pressure

1. eventually, pressure in ventricle exceeds that in the arteries, causing semilunar valves to open
2. causes AV valves to be pulled down, causing drop in atrial pressure
3. when pressure difference cause blood flow to want to go back into the ventricle, semilunar valves will close (second heart sound)
   1. cause appearance of incisura on Wigger diagram
4. at the end, you have the ESV

1. both AV and semilunar valves closed
2. pressure in atria slowly rises
3. When pressure in ventricle is less than atrial pressure, AV valve open
   1. at first rapid (first 2/3 of volume gets in during the first one third of diastole)

1. AV valve is open, but semilunar valve is closed, no outflow
2. pressure is buidling up in the ventricle, and the rate of filling will progressively decline

• systole (1/3)- 0.25-0.3 sec
• diastole (2/3)- 0.5 sec

• back flow into the coronary arteries
• regurgitation into the ventricle
• rebound of the valve

MAP= 1/3 max value of arterial systolic pressure (SP) + 2/3 minimal arterial diastolic pressure (DP)

arterial systolic pressure - arterial diastolic pressure

Sounds heard on sphygomomanometer

• systolic- begin with snapping tones and progresses to thumping/muffling
• diastolic- eventual silence

NOT HEART SOUNDS!!!!!!!!!!

When takin a blood pressure, what sounds are we hearing?

EF= (EDV-ESV)/EDV

normal = 0.6-0.7

compromised = 0.5

grave = 0.3

first: AV valve closure

second: semilunar valve closeed

third (in youth): during rapid filling period (diastole)

Explain what we are hearin when we hear splitting of second heart sound and what can make this sound more apparent

• pulmonary valve closes a little bit LATER than aortic valve
• can be accentuated by a deep inspiration due to larger amount of blood being ejected and duration of contraction increases

• aortic valve close AFTER pulmonary valve
• if you had a deep inspiration, you lessen the splitting by delaying pulmonary closure

Definition and effect of valve stenosis

• definition-  orifice of valve narrowed
• effect- velocity increases, resistance increases, and flow is turbulent (Reynold's ratio)

• definition- incomplete closure, leaky valve

Sounds heard with stethoscope during aortic incompetence

AV stenosis will sense turbulent flow during what part of the cardiac cycle? AV insufficiency?

W = ΔV X ΔP = SV X aortic P

• decrease EDV
• decrease SV
• decrese external work
• decrease external work/internal work ratio

LESS EFFECTIVE PUMPING

• decrease ESV
• increase SV
• increase external work
• increase external work/internal work ratio

MORE EFFECTIVE PUMP

• increase ESV
• decrease SV
• decrease external work
• decrease external work/internal work ratio

LESS EFFECTIVE PUMPING

• increase in EDV
• increase SV
• increase external energy
• increase external energy/internal energy ratio

MORE EFFECTIVE PUMP