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1. Isovolumetric (IV) contraction

Phases of Cardiac cycle:. 1. Isovolumetric (IV) contraction. 2. Rapid ejection. 3. Reduced ejection. 4. Protodiastole. 5. Isovolumetric relaxation. 6. First rapid filling. 7. Slow filling. 8. Last rapid filling (Atrial systole). Aortic pressure curve. 120. Left atrial pressure curve.

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1. Isovolumetric (IV) contraction

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  1. Phases of Cardiac cycle: 1. Isovolumetric (IV) contraction 2. Rapid ejection 3. Reduced ejection 4. Protodiastole 5. Isovolumetric relaxation 6. First rapid filling 7. Slow filling 8. Last rapid filling (Atrial systole)

  2. Aortic pressure curve 120 Left atrial pressure curve 100 80 Lt.Ventricular pressure curve 60 AC MO 40 AO MC 20 DIASTOLE SYSTOLE DIASTOLE 0 Time(secs) 0.8 0.6 0.7 0.2 0.5 0 0.1 0.3 0.4 Contd: Pressure (mm Hg) v a c JVP: 7 8 4 5 6 Events: 8 3 1 2

  3. AC AO Pressure (mm Hg) 120 a c End diastolic volume 80 End systolic volume v 40 MC MO 130 90 R 0 50 Q S 0 0.4 0.8 0.1 Time (secs) Aortic pressure curve Lt V. Pr. curve Lt A. Pr. curve Volume (mL) P ECG Phonocardiogram Lt V. Volume curve

  4. Pressure – volume loop of left Ventricle: • Definition:

  5. 120 80 Left Ventricular pressure (mm Hg) 40 0 50 100 150 Left Ventricular volume (ml) NORMAL PRESSURE –VOLUME LOOP OF LEFT VENTRICLE D E C B A1 A

  6. Advantage of pressure – Volume loop: • Disadvantage of pressure – Volume loop: • Clinical significance of Pressure – Volume loop: VENTRICULAR DYSFUNCTIONS: Systolic dysfunction: Diastolic dysfunction:

  7. 120 e1 c1 e c 80 Left Ventricular pressure (mm Hg) b1 40 a1 a b 0 50 100 150 Left Ventricular volume (ml) EFFECTS OF VENTRICULAR DYSFUNCTIONS ON PRESSURE –VOLUME LOOP Systolic dysfunction D E C B A

  8. AC AO Pressure (mm Hg) 120 80 ECG P 40 MC MO R 0 Phonocardiogram Q S QS2 LVET PEP ELECTROMECHANICAL EVENT Electromechanical systole Lt. Ventricular ejection time ELECTROMECHANICAL EVENT Pre-ejection period

  9. IVC IVR c v a S2 S1 Diastole Systole Isovolumetric contraction IVC IVR Isovolumetric relaxation JUGULAR VENOUS PULSE (JVP): Waves of JVP: a wave - x c wave - v wave - z y x descent - y descent - z descent -

  10. Raised JVP - Conditions that alter JVP: Prominent ‘a’ wave - Physiological basis - Cannon wave - Causes:

  11. a c v Cannon wave: Giant ‘a’ wave Absence of ‘a’ wave - Prominent ‘v’ wave -

  12. R Q S Heart sounds: • 1st 2nd 3rd 4th • CHARACTERISTICS: • Duration (sec): • Frequency (Hz): • Cause (main): • Related event: • Correlation with ECG: P ECG Phonocardiogram

  13. Ribs 1 2 Pulmonary area 3 Aortic area 4 5 Sternum Mitral area Tricuspid area Auscultatory areas: Midclavicular line

  14. Cardiac murmurs: • Definition: • Mechanism of production: • Causes: • Types:

  15. Genesis of murmurs: Systolic murmur A-V incompetance Normal

  16. Diastolic murmur A-V Stenosis Normal

  17. Systolic murmur Semilunar valve Stenosis Normal

  18. Diastolic murmur Semilunar valve Incompetance Normal

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