CICLO CARDÍACO

Juan José Diaztagle Fernández

Esp. Medicina Interna, Epidemiología,
Msc Fisiología
[email protected]
Cel. 3157951136
Objetivos de
Aprendizajes
• Definir que es el ciclo cardíaco.
• Reconocer los eventos eléctricos y
mecánicos en un ciclo cardíaco
• Describir los cambios de volumen
(ventricular) y presión (auricular y
ventricular) durante las fases del ciclo
cardíaco.
• Explicar el asa presión-volumen y reconocer
las 4 fases.
• Aplicar los conceptos básicos de ciclo
cardíaco en condiciones clínicas comunes.
 ¿Qué es el ciclo cardíaco?

“El ciclo cardíaco es la secuencia de eventos mecánicos y

eléctricos que se repiten con cada latido cardíaco”

“los eventos cardíacos que ocurren desde el inicio de un

latido cardíaco hasta el inicio del próximo latido”
Electrical Conduction in Heart
1
1
SA node
AV node

THE CONDUCTING SYSTEM 1 SA node depolarizes.

OF THE HEART

SA node

Internodal
pathways

AV node

A-V bundle
Bundle branches
Purkinje
fibers

Purple shading in steps 2–5 represents depolarization.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-18, step 1
Electrical Conduction in Heart
1
1
SA node
AV node
2

THE CONDUCTING SYSTEM 1 SA node depolarizes.

OF THE HEART

2 Electrical activity goes

rapidly to AV node via
SA node internodal pathways.
Internodal
pathways

AV node

A-V bundle
Bundle branches
Purkinje
fibers

Purple shading in steps 2–5 represents depolarization.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-18, steps 1–2
Electrical Conduction in Heart
1
1
SA node
AV node
2

THE CONDUCTING SYSTEM 1 SA node depolarizes.

OF THE HEART

2 Electrical activity goes

rapidly to AV node via
SA node internodal pathways.
3
Internodal
pathways
3 Depolarization spreads
more slowly across
atria. Conduction slows
through AV node.

AV node

A-V bundle
Bundle branches
Purkinje
fibers

Purple shading in steps 2–5 represents depolarization.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-18, steps 1–3
Electrical Conduction in Heart
1
1
SA node
AV node
2

THE CONDUCTING SYSTEM 1 SA node depolarizes.

OF THE HEART

2 Electrical activity goes

rapidly to AV node via
SA node internodal pathways.
3
Internodal
pathways
3 Depolarization spreads
more slowly across
atria. Conduction slows
through AV node.

AV node
4 Depolarization moves
A-V bundle rapidly through ventricular
4
Bundle branches conducting system to the
Purkinje apex of the heart.
fibers

Purple shading in steps 2–5 represents depolarization.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-18, steps 1–4
Electrical Conduction in Heart
1
1
SA node
AV node
2

THE CONDUCTING SYSTEM 1 SA node depolarizes.

OF THE HEART

2 Electrical activity goes

rapidly to AV node via
SA node internodal pathways.
3
Internodal
pathways
3 Depolarization spreads
more slowly across
atria. Conduction slows
through AV node.

AV node
4 Depolarization moves
A-V bundle rapidly through ventricular
4
Bundle branches conducting system to the
Purkinje apex of the heart.
fibers
5 Depolarization wave
5 spreads upward from
the apex.

Purple shading in steps 2–5 represents depolarization.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-18, steps 1–5
Mechanical Events

1 Late diastole: both sets of

chambers are relaxed and
START
ventricles fill passively.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-24, step 1
Mechanical Events

1 Late diastole: both sets of

chambers are relaxed and
START
ventricles fill passively.

2 Atrial systole: atrial contraction

forces a small amount of
additional blood into ventricles.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-24, steps 1–2
Mechanical Events

1 Late diastole: both sets of

chambers are relaxed and
START
ventricles fill passively.

2 Atrial systole: atrial contraction

forces a small amount of
additional blood into ventricles.

Isovolumic ventricular
3 contraction: first phase of
ventricular contraction pushes
AV valves closed but does not
create enough pressure to open
semilunar valves.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-24, steps 1–3
Mechanical Events

1 Late diastole: both sets of

chambers are relaxed and
START
ventricles fill passively.

2 Atrial systole: atrial contraction

forces a small amount of
additional blood into ventricles.

Isovolumic ventricular
Ventricular ejection: 3 contraction: first phase of
4 as ventricular pressure ventricular contraction pushes
rises and exceeds AV valves closed but does not
pressure in the arteries, create enough pressure to open
the semilunar valves semilunar valves.
open and blood is
ejected.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-24, steps 1–4
Mechanical Events

1 Late diastole: both sets of

chambers are relaxed and
START
ventricles fill passively.

Isovolumic ventricular
5 relaxation: as ventricles
2 Atrial systole: atrial contraction
relax, pressure in ventricles forces a small amount of
falls, blood flows back into additional blood into ventricles.
cups of semilunar valves
and snaps them closed.

Isovolumic ventricular
Ventricular ejection: 3 contraction: first phase of
4 as ventricular pressure ventricular contraction pushes
rises and exceeds AV valves closed but does not
pressure in the arteries, create enough pressure to open
the semilunar valves semilunar valves.
open and blood is
ejected.

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-24, steps 1–5
Cardiac Cycle

Left ventricular pressure-volume changes during one

cardiac cycle
KEY
EDV = End-diastolic volume
ESV = End-systolic volume

Stroke volume
120
D

Left ventricular pressure (mm Hg)

ESV

80 C
One
cardiac
cycle

40
EDV

B
A

0 65 100 135
Left ventricular volume (mL)

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-25
Cardiac Cycle

KEY
EDV = End-diastolic volume
ESV = End-systolic volume

120

Left ventricular pressure (mm Hg)

80

40
Apertura de la
Válvula Mitral
A

0 65 100 135
Left ventricular volume (mL)

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-25 (1 of 4)
Cardiac Cycle

KEY
EDV = End-diastolic volume
Fase de llenado ESV = End-systolic volume

Presiones VI: Bajas

Volumen VI: Aumenta 120

Left ventricular pressure (mm Hg)

hasta 120-135

80

40
Apertura de la EDV
Cierre de la
Válvula Mitral
B
Válvula Mitral
A

0 65 100 135
Left ventricular volume (mL)

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-25 (2 of 4)
 Cardiac Cycle

KEY
EDV = End-diastolic volume
Fase de contracción ESV = End-systolic volume

isovolumétrica
Presiones VI: aumenta 120

Left ventricular pressure (mm Hg)

hasta 80 mmHg
Volumen VI: no se
modifica 80 C
Apertura de la
Válvula Aórtica

40
EDV
Cierre de la
B
Válvula Mitral
A

0 65 100 135
Left ventricular volume (mL)

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-25 (3 of 4)
Cardiac Cycle

KEY

Cierre de la
EDV = End-diastolic volume
Fase de eyección ESV = End-systolic volume
Válvula Aórtica
Presiones VI: Aumenta Stroke volume
hasta 120 mmHg 120
D

Left ventricular pressure (mm Hg)

Volumen VI: Disminuye ESV

80 C
Apertura de la
One Válvula Aórtica
cardiac
cycle

40
EDV

B
A

0 65 100 135
Left ventricular volume (mL)

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-25 (4 of 4)
 Cardiac Cycle

KEY

Cierre de la
EDV = End-diastolic volume
Fase de relajación ESV = End-systolic volume
Válvula Aórtica
isovolumétrica Stroke volume
Presiones VI: 120
D

Left ventricular pressure (mm Hg)

disminuye ESV Volumen Sistólico =
Volumen VI: no se 70 mL
modifica 80 C
One
cardiac FE= VS / VTD
cycle
FE=?
40
Apertura de la EDV

Válvula Mitral
B
A

0 65 100 135
Left ventricular volume (mL)

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-25 (4 of 4)
Copyright ©2007 Pearson Education, Inc., publishing as Benjamin Cummings
Wiggers Diagram
Time (msec)
0 100 200 300 400 500 600 700 800

Electro- QRS QRS

complex Cardiac cycle complex
cardiogram
(ECG) P T P

120

90 Aorta Dicrotic
Pressure notch
(mm Hg)
Left
60 ventricular
pressure
Left atrial
30 pressure

Heart S1 S2
sounds
135
Left
ventricular
volume
(mL) 65
Atrial Ventricular Ventricular Atrial
systole systole diastole systole

Atrial systole Isovolumic Ventricular Early Late Atrial

ventricular systole ventricular ventricular systole
contraction diastole diastole
Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26
Wiggers Diagram
Time (msec)
0

Electro-
cardiogram
(ECG) P Fase de llenado Ventricular
120
(Período de contracción
auricular)
90 Aorta
Pressure
(mm Hg)
Left
60 ventricular
pressure
Left atrial
30 pressure
La contracción auricular causa un
ligero aumento de la presión
Heart
intraauricular e intraventricular
sounds
135
Left
ventricular En reposos, la contracción auricular
volume
(mL) 65
Atrial
transfiere hasta 20% del volumen
systole
sanguíneo

Atrial systole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (8 of 13)
Wiggers Diagram
Time (msec)
0 100
Electro-
cardiogram
Fase de contracción
(ECG) P
Isovolumétrica
120

90 Aorta
Pressure
(mm Hg)
La presión del VI aumenta
Left
60 ventricular rápidamente
pressure
Left atrial
30 pressure
Cuando la presión del VI
excede la de la AI se cierra
Heart
sounds la válvula mitral
135
Left
ventricular
volume
65
(mL)
Atrial El ventrículo se contrae
systole
contra la válvula
aortica cerrada (No hay
cambio de volumen)
Isovolumic
ventricular
contraction

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (9 of 13)
Wiggers Diagram
Time (msec)
0 100 200 300
QRS
Electro-
cardiogram
P
complex
T
Fase de eyección
(ECG)

120

Inicia con la apertura de la

Aorta
Pressure
90
válvula Aórtica.
(mm Hg)
Left
60 ventricular
pressure
Left atrial
30 pressure La presión del VI y de la
aorta aumentan
Heart S1 progresivamente.
sounds
135
Left
ventricular El volumen ventricular se
volume
(mL) 65 reduce. Cerca de 70 ml de
Atrial Ventricular
systole systole sangre fluyen por la aorta.

Ventricular
systole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (10 of 13)
Wiggers Diagram
Time (msec)
0 100 200 300 400
Electro-
cardiogram
P
QRS
complex Fase de
(ECG) T
Relajación
120
Isovolumétrica
90 Aorta Dicrotic
Pressure notch Inicia cuando la presión del VI
(mm Hg)
60
Left
ventricular
cae por debajo de la presión
Left atrial
pressure
aortica (cierre válvula aórtica)
30 pressure

Heart S1 S2
sounds
135
Left Las válvulas están cerradas no
ventricular
volume
65
existe cambios en el volumen
(mL)
Atrial Ventricular
systole systole

Early
ventricular
diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (11 of 13)
Wiggers Diagram
Time (msec)
0 100 200 300 400 500 600 700 800
Electro- QRS
complex Cardiac cycle
cardiogram
(ECG) P T

120

La presión en la aorta
90 Aorta
Pressure
Dicrotic
notch cae debido a que la
(mm Hg)
60
Left
ventricular
sangre sigue fluyendo
pressure
Left atrial
30 pressure
Inicia cuando la
Heart S1 S2 presión del VI cae
sounds
135 por debajo de la AI
Left
ventricular
volume
(mL) 65
Atrial Ventricular Ventricular
systole systole diastole

Fase de Llenado Ventricular

(Llenado ventricular rápido y Late
Diastasis) ventricular
diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (12 of 13)
Wiggers Diagram
Time (msec)
0 100 200 300 400 500 600 700 800
Electro- QRS QRS
complex Cardiac cycle complex
cardiogram
(ECG) P T P

120

90 Aorta Dicrotic
Pressure notch
(mm Hg)
Left
60 ventricular
pressure
Left atrial
30 pressure

Heart S1 S2
sounds
135
Left
ventricular
volume
(mL) 65
Atrial Ventricular Ventricular Atrial
systole systole diastole systole

Atrial systole Isovolumic Ventricular Early Late Atrial

ventricular systole ventricular ventricular systole
contraction diastole diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (13 of 13)
Graci
as
Wiggers Diagram

Time (msec)
0 100 200 300 400 500 600 700 800
Electro- QRS Cardiac cycle QRS
cardiogram complex complex
(ECG) P T P

Atrial Ventricular Ventricular Atrial

systole systole diastole systole

Atrial systole Isovolumic Ventricular Early Late Atrial

ventricular systole ventricular ventricular systole
contraction diastole diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (1 of 13)
Wiggers Diagram

Time (msec)
0 100 200 300 400 500 600 700 800
135
Left
ventricular
volume
(mL) 65
Atrial Ventricular Ventricular Atrial
systole systole diastole systole

Atrial systole Isovolumic Ventricular Early Late Atrial

ventricular systole ventricular ventricular systole
contraction diastole diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (2 of 13)
Wiggers Diagram

Time (msec)
0 100 200 300 400 500 600 700 800

90
Pressure
(mm Hg)
60

30
Left atrial
pressure

Left 135
ventricular
volume
(mL)
65
Atrial Ventricular Ventricular Atrial
systole systole diastole systole

Atrial systole Isovolumic Ventricular Early Late Atrial

ventricular systole ventricular ventricular systole
contraction diastole diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (3 of 13)
Wiggers Diagram

Time (msec)
0 100 200 300 400 500 600 700 800
120

90
Pressure
(mm Hg)
Left
60 ventricular
pressure

30

Heart S1 S2
sounds
135 Atrial Ventricular Ventricular Atrial
systole systole diastole systole

Atrial systole Isovolumic Ventricular Early Late Atrial

ventricular systole ventricular ventricular systole
contraction diastole diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (4 of 13)
Wiggers Diagram

Time (msec)
0 100 200 300 400 500 600 700 800

90
Pressure
(mm Hg)
60

Left
ventricular
30 pressure

Left 135 S2
S1
ventricular
volume
(mL)
65
Atrial Ventricular Ventricular Atrial
systole systole diastole systole

Atrial systole Isovolumic Ventricular Early Late Atrial

ventricular systole ventricular ventricular systole
contraction diastole diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (5 of 13)
Wiggers Diagram

Time (msec)
0 100 200 300 400 500 600 700 800
120

90 Aorta Dicrotic
Pressure notch
(mm Hg)
Left
60 ventricular
pressure

30

Heart S1 S2
sounds
Atrial Ventricular Ventricular Atrial
systole systole diastole systole

Atrial systole Isovolumic Ventricular Early Late Atrial

ventricular systole ventricular ventricular systole
contraction diastole diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (6 of 13)
Wiggers Diagram

Time (msec)
0 100 200 300 400 500 600 700 800
120

90 Aorta Dicrotic
Pressure notch
(mm Hg)
Left
60 ventricular
pressure
Left atrial
30 pressure

Heart S1 S2
sounds
Atrial Ventricular Ventricular Atrial
systole systole diastole systole

Atrial systole Isovolumic Ventricular Early Late Atrial

ventricular systole ventricular ventricular systole
contraction diastole diastole

Copyright © 2007 Pearson Education, Inc., publishing as Benjamin Cummings Figure 14-26 (7 of 13)