આ MCQ મોડ્યુલ આના પર આધારિત છે: Cardiac Cycle Ecg Circulation
Cardiac Cycle Ecg Circulation
આ મૂલ્યાંકન આના પર આધારિત હશે: Cardiac Cycle Ecg Circulation
મૂલ્યાંકન બનાવવામાં તેમની સામગ્રી સામેલ કરવા ચિત્રો, PDF અથવા Word દસ્તાવેજ અપલોડ કરો.
The Cardiac Cycle, ECG, Double Circulation and Disorders
Part 3 built the pump. This part sets it running — following one complete beat from the SAN's first impulse to the closing of the last valve, then reading that beat off an ECG trace, tracing where the blood actually goes, and finally examining what happens when the system fails.
15.3.2 Cardiac Cycle
Stage 1 — joint diastole
To begin with, all the four chambers of the heart are in a relaxed state, i.e., they are in joint diastole. As the tricuspid and bicuspid valves are open, blood from the pulmonary veins and vena cava flows into the left and the right ventricle respectively through the left and right atria. The semilunar valves are closed at this stage.
Stage 2 — atrial systole
The SAN now generates an action potential which stimulates both the atria to undergo a simultaneous contraction — the atrial systole. This increases the flow of blood into the ventricles by about 30 per cent.
Stage 3 — ventricular systole
The action potential is conducted to the ventricular side by the AVN and AV bundle, from where the bundle of His transmits it through the entire ventricular musculature. This causes the ventricular muscles to contract (ventricular systole), while the atria undergo relaxation (diastole), coinciding with the ventricular systole.
What follows is a strict sequence of pressure changes and valve movements:
- Ventricular systole increases the ventricular pressure, causing the closure of tricuspid and bicuspid valves due to attempted backflow of blood into the atria.
- As the ventricular pressure increases further, the semilunar valves guarding the pulmonary artery (right side) and the aorta (left side) are forced open, allowing the blood in the ventricles to flow through these vessels into the circulatory pathways.
Stage 4 — ventricular diastole, and back to the start
- The ventricles now relax (ventricular diastole) and the ventricular pressure falls, causing the closure of semilunar valves, which prevents the backflow of blood into the ventricles.
- As the ventricular pressure declines further, the tricuspid and bicuspid valves are pushed open by the pressure in the atria exerted by the blood which was being emptied into them by the veins.
- The blood now once again moves freely to the ventricles. The ventricles and atria are now again in a relaxed (joint diastole) state, as earlier.
- Soon the SAN generates a new action potential and the events described above are repeated in that sequence, and the process continues.
The numbers of the cardiac cycle
As mentioned earlier, the heart beats 72 times per minute, i.e., that many cardiac cycles are performed per minute. From this it could be deduced that the duration of a cardiac cycle is 0.8 seconds.
= 70 mL × 72 min⁻¹ = 5040 mL ≈ 5 litres per minute
The body has the ability to alter the stroke volume as well as the heart rate, and thereby the cardiac output. For example, the cardiac output of an athlete will be much higher than that of an ordinary man.
The heart sounds
• The first heart sound (lub) is associated with the closure of the tricuspid and bicuspid valves.
• The second heart sound (dub) is associated with the closure of the semilunar valves.
These sounds are of clinical diagnostic significance.
15.3.3 Electrocardiogram (ECG)
To obtain a standard ECG, a patient is connected to the machine with three electrical leads (one to each wrist and to the left ankle) that continuously monitor the heart activity. For a detailed evaluation of the heart's function, multiple leads are attached to the chest region.
Each peak in the ECG is identified with a letter from P to T that corresponds to a specific electrical activity of the heart.
| Wave | What it represents | Mechanical event |
|---|---|---|
| P-wave | The electrical excitation (or depolarisation) of the atria | Leads to the contraction of both the atria |
| QRS complex | The depolarisation of the ventricles | Initiates the ventricular contraction. The contraction starts shortly after Q and marks the beginning of the systole |
| T-wave | The return of the ventricles from excited to normal state (repolarisation) | The end of the T-wave marks the end of systole |
15.4 Double Circulation
The three layers of a blood vessel
The blood flows strictly by a fixed route through blood vessels — the arteries and veins. Basically, each artery and vein consists of three layers:
| Layer | Composition |
|---|---|
| Tunica intima (inner) | An inner lining of squamous endothelium |
| Tunica media (middle) | Smooth muscle and elastic fibres — comparatively thin in the veins |
| Tunica externa (outer) | Fibrous connective tissue with collagen fibres |
The two circuits
• Hepatic portal system: a unique vascular connection exists between the digestive tract and liver. The hepatic portal vein carries blood from intestine to the liver before it is delivered to the systemic circulation.
• Coronary system: a special coronary system of blood vessels is present in our body exclusively for the circulation of blood to and from the cardiac musculature.
15.5 Regulation of Cardiac Activity
Regulation from outside can only modify that intrinsic rhythm, never create it:
- A special neural centre in the medulla oblongata can moderate the cardiac function through the autonomic nervous system (ANS).
- Neural signals through the sympathetic nerves (part of ANS) can increase the rate of heart beat, the strength of ventricular contraction and thereby the cardiac output.
- Parasympathetic neural signals (another component of ANS) decrease the rate of heart beat, speed of conduction of action potential and thereby the cardiac output.
- Adrenal medullary hormones can also increase the cardiac output.
| Influence | Effect on heart rate | Effect on cardiac output |
|---|---|---|
| Sympathetic nerves | Increase, and also increase the strength of ventricular contraction | Increases |
| Parasympathetic nerves | Decrease, and also decrease the speed of conduction of action potential | Decreases |
| Adrenal medullary hormones | Increase | Increases |
15.6 Disorders of Circulatory System
What to do. Working in pairs, place two fingers on the radial artery at your partner's wrist and count the pulse for one full minute while they sit quietly. Record it. Then have them do two minutes of brisk exercise — stepping or jogging on the spot — and immediately count the pulse again for one minute. Continue counting each minute until the rate returns to its resting value, and note how long that takes.
Now calculate, for both the resting and the exercising state, the cardiac output, taking stroke volume as 70 mL. Also work out the duration of one cardiac cycle in each state.
Typical readings. Resting pulse about 72 per minute, matching the chapter's statement that our heart normally beats 70–75 times in a minute (average 72 beats min⁻¹). After exercise it may reach 120–150, and it returns to resting value over two to five minutes — faster in a fitter person.
The calculations. At rest, cardiac output = stroke volume × heart rate = 70 × 72 = 5040 mL, which is the chapter's figure of 5000 mL or 5 litres. The duration of a cardiac cycle is 60 ÷ 72 = 0.8 seconds. At a pulse of 140, output rises to 70 × 140 = 9800 mL even without any change in stroke volume, and the cycle shortens to 60 ÷ 140 ≈ 0.43 seconds.
Which factor changes more. Both change, but heart rate is the larger and quicker lever — the chapter notes that the body has the ability to alter the stroke volume as well as the heart rate, and thereby the cardiac output. Stroke volume also rises during exercise, because sympathetic signals increase the strength of ventricular contraction as well as the rate. Taken together they can raise output several-fold, which is why the cardiac output of an athlete will be much higher than that of an ordinary man.
Which nerves did it. The sympathetic division, since neural signals through the sympathetic nerves can increase the rate of heart beat, the strength of ventricular contraction and thereby the cardiac output; adrenal medullary hormones reinforce the same effect. The recovery afterwards is largely the parasympathetic division, which decreases the rate of heart beat, the speed of conduction of action potential and thereby the cardiac output.
One conclusion worth writing down. Note what the exercise does not do: it never starts or stops the beat. The rhythm comes from the nodal tissue, which is autoexcitable, and the nerves only moderate it — which is precisely what is meant by calling the heart myogenic.
🎯 Interactive: Where are you in the cardiac cycle?
Valves and blood: AV valves open, semilunar valves closed
All four chambers are relaxed. As the tricuspid and bicuspid valves are open, blood from the pulmonary veins and vena cava flows into the left and right ventricles through the atria. About 70 per cent of ventricular filling happens in this passive stage.
🎯 Competency-Based Questions
Q1. Calculate the cardiac output of patients X and Y and comment on who is likely to be an athlete. L3 Apply
Patient X is likely to be the athlete. X achieves the normal 5 litres per minute with a heart rate well below the usual 70–75, because each beat ejects a far larger stroke volume than the usual 70 mL — a strong, efficient heart that need not beat often. Patient Y is beating fast yet delivering less than normal output, which suggests a weak ventricle compensating by raising its rate. The example shows why cardiac output, not heart rate alone, is the meaningful measure.
Q2. What is happening in patient Z, and where in the heart does the fault lie? L4 Analyse
Q3. Fill in the blanks: The duration of a cardiac cycle is ______ seconds. Each ventricle pumps out about ______ mL per cycle, called the ______, and the cardiac output averages ______ litres. The first heart sound is due to closure of the ______ valves and the second of the ______ valves. L1 Remember
Q4. A student claims the pulmonary artery must carry oxygenated blood because “arteries always carry oxygenated blood”. Correct the error and explain what actually defines an artery. L4 Analyse
What actually defines an artery is the direction of flow relative to the heart: an artery carries blood away from the heart and a vein carries it towards the heart, whatever the blood's oxygen content. The structural correlate follows from pressure, not from oxygen: the tunica media of smooth muscle and elastic fibres is comparatively thin in the veins, because arteries must withstand the pressure generated by ventricular systole. The student has mistaken a statistical generalisation — true of the systemic circulation — for a definition.
Q5. “Since the heart is myogenic, the nervous system has no real role in controlling it.” Evaluate. L5 Evaluate
What is right. Normal activities of the heart are regulated intrinsically, i.e., auto regulated by specialised muscles (nodal tissue), hence the heart is called myogenic. The nodal musculature has the ability to generate action potentials without any external stimuli, and the SAN generates the maximum, 70–75 per minute. So the heart needs no nerve to beat at all — a denervated or even an excised heart continues beating, which is what makes transplantation possible.
Why the nervous system nevertheless matters. (i) The body's demand is not constant. An intrinsic rate of 72 is right for rest and hopelessly inadequate for running. A special neural centre in the medulla oblongata can moderate the cardiac function through the autonomic nervous system, and sympathetic nerves increase the rate of heart beat, the strength of ventricular contraction and thereby the cardiac output — raising output several-fold, which is how the cardiac output of an athlete becomes much higher than that of an ordinary man. (ii) Output must also be lowered. Parasympathetic neural signals decrease the rate of heart beat, the speed of conduction of action potential and thereby the cardiac output, conserving the heart at rest. (iii) Hormones add a third layer: adrenal medullary hormones can also increase the cardiac output. (iv) The neural centre is part of a larger loop — the same medulla receives information from the aortic arch and carotid receptors met in Chapter 14, so cardiac and respiratory adjustments are made together.
The accurate formulation: the rhythm is myogenic, but its rate and force are neurally and hormonally moderated. The design is a good one — a self-starting pump that cannot be switched off by accident, with adjustable output layered on top.
🧠 Assertion–Reason Questions
For each pair choose: (A) Both A and R are true and R is the correct explanation of A. (B) Both A and R are true but R is not the correct explanation of A. (C) A is true but R is false. (D) A is false but R is true.
Assertion (A): The first heart sound, lub, marks the beginning of ventricular systole.
Reason (R): It is associated with the closure of the tricuspid and bicuspid valves, which occurs when rising ventricular pressure attempts to drive blood back into the atria.
Assertion (A): The pulmonary artery carries deoxygenated blood.
Reason (R): An artery is defined by carrying blood away from the heart, not by the oxygen content of that blood.
Assertion (A): Heart failure and cardiac arrest are the same condition.
Reason (R): Heart failure is sometimes called congestive heart failure, because congestion of the lungs is one of its main symptoms.