THE CARDIAC CYCLE

The human heart is situated between the two lungs in the intra-thoracic cavity.
The heart weighs approximately 125g in a healthy human and is considered to be the
size of a clenched human fist. The apex of the heart is situated to the left of
the midline and is described anatomically as being in the left mid-nipple line in
the fourth inter-costal space in a man.

The heart is divided into four chambers, the 2 receiving chambers being the atria
(singular – atrium), while the two ventricles are strong and muscular and are
responsible for ejecting blood out of the heart. The left side is completely
separated from the right side by the inter- atrioventricular septum. The right
atrium is separated from the right ventricle by the tricuspid valve, while the
left atrium is separated from the left ventricle by the bicuspid (mitral) valve.
The right side receives deoxygenated blood from the body via the superior and
inferior venacavae, which open independently into the right atrium. In a similar
sense, the left atrium receives blood returning after oxygenation from the lungs
via two pairs of pulmonary veins.

Blood received by the two atria flows directly into the two ventricles, but this
ventricular filling is enhanced by the contraction of the atrial walls (atrial
systole). During atrial systole the two atrio-ventricular valves remain open while
the two semi-lunar valves (situated at the entrance of the pulmonary artery and
aorta) remain closed.

Following atrial systole the two ventricles prepare for their contraction. The
onset of ventricular systole is marked by a brief isometric phase, during which
time all four valves close and an enormous tension builds up in the ventricle
walls. The tension developed in the left ventricular wall far exceeds that of the
right ventricle, as the musculature on the left side is substantially thicker than
that of the right. This is a functional adaptation brought about to help the left
ventricle generate a pressure strong enough to propel the blood through the entire
systemic circulation.

During ventricular systole the pressure in the left ventricle reaches

approximately 120 mm Hg. The ventricular wall then contracts powerfully, ejecting
all the blood contained in it into the aorta. A similar process occurs on the
right side except that pressures rarely exceed 25mm Hg. Since the pressure in the
ventricles far exceed that of the great arteries, blood pulsates out along a
pressure gradient, forcing the semi-lunar valves open. Towards the end of
ventricular ejection, there comes a point when the blood has diminished so much in
the left ventricle and increased so much in the aorta, that the pressure in the
aorta begins to exceed that of the ventricle. At this point, due to reversing
pressure gradients, reverse flow may occur, but the semi-lunar valve snaps shut so
that backflow of blood is prevented.
Following ventricular systole, the entire heart undergoes relaxation (diastole)
during which time all four valves are open. As the heart muscle relaxes, recoils
and expands there is the simultaneous filling of blood, which marks the onset of a
new cardiac cycle.

It is important to note that the two atria and the two ventricles although
structurally separated, contract together as one, augmenting the effect of each
other synergistically so that the beats are rhythmic and controlled as one fluid
cycle.

The human circulation comprises of a deoxygenated systemic (body) circulation and

an oxygenated pulmonary (lung) circulation, which are connected and controlled by
the central pump, which is the heart. Humans therefore have a double closed
circulation.