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          (ventricular). The first sound marks the   the same. If these are not equal, blood
                                                  tends to accumulate in either the systemic
          beginning of systole, and the second sound
  VetBooks.ir  marks the beginning of diastole (Fig. 18‐3).  or pulmonary circulation.

          Systole
                                                  Diastole
          As the ventricles begin their contraction,   At the beginning of diastole, both the semi­
          the pressure within the ventricle increases.   lunar and A‐V valves are closed, so the initial
          Almost immediately, the pressure within   phase is termed  isovolumetric relaxation.
          each ventricle exceeds the pressure within   When  ventricular relaxation reaches the
          their respective atria, and the pressure dif­  point that atrial blood pressures exceed ven­
          ferences force the atrioventricular (A‐V)   tricular blood pressures, the pressure differ­
          valves closed. The first heart sound is asso­  ences open the A‐V valves. While the A‐V
          ciated with closure of the right and left   valves are closed during systole and early
          A‐V valves (Fig. 18‐3).                 diastole, blood continues to flow into the
            The ventricles continue to contract and
          pressure continues to increase during the   right and left atria  from the systemic and
                                                  pulmonary circulations, respectively. The
          early part of systole. At this point in the   accumulation of blood within the atria
          cycle, all four heart valves are closed, and all   increases atrial blood pressure. When A‐V
          remain closed until pressure in the ventri­  valves open, much of the accumulated blood
          cles exceeds that in the arterial vessels that   flows rapidly into the ventricles. Most ven­
          they supply (aorta for left ventricle and pul­  tricular filling occurs during this period
          monary trunk for right ventricle). The   prior to any atrial contraction (Fig. 18‐3).
          period of systole during which all valves are   Blood  continues  to  flow  into  the  atria
          closed is the  isovolumetric contraction   throughout diastole, and because the A‐V
          period, because during it the volume of   valves are open, blood  flows directly
          each ventricle remains constant (Fig. 18‐3).  through the atria into the ventricles. As
            When ventricular pressures exceed those
          in their respective arterial vessels, the semi­  mentioned earlier, diastole is the phase of
                                                  the cardiac cycle that lengthens most with
          lunar valves open to permit ejection of   slow heart rates, so slow heart rates pro­
          blood. There is no sound associated with the   vide a long period for ventricular filling.
          opening of the semilunar valves. An initial   Atrial contraction (atrial systole) occurs
          rapid ejection phase of systole is followed by   during ventricular diastole, forcing an
          a reduced ejection phase,  during which ven­  additional volume of blood into the ventri­
          tricular and arterial pressures fall (Fig. 18‐3).  cles, but this amount is relatively small
            The  elasticity  of  the  aorta  and  pulmo­
          nary trunk maintains blood pressure in   (perhaps 15%) compared to the volume
                                                  already in the ventricles.
          these  vessels even  though  the  ventricles   The volume of blood in each ventricle at
          begin to relax. When the blood pressures in
          these vessels are greater than the pressures   the end of diastole is the  end‐diastolic
                                                  volume (EDV). During systole, each ven­
          in their associated ventricles, the pressure   tricle ejects only a percentage of its EDV
          differences close the semilunar valves. The   (Fig.  18‐2),  typically  40  to  60%.  The  per­
          second heart sound is associated with   centage of the EDV that is ejected is the
            closure of the aortic and pulmonary valves,   ejection fraction.
          and this sound is used to mark the end of
          systole (ventricular) and the beginning of
          diastole (ventricular) (Fig. 18‐3).     Heart Sounds and Murmurs
            Stroke volume is the volume of blood
          ejected from each ventricle during a single   The first and second heart sounds are asso­
          cardiac cycle. Normally, the stroke vol­  ciated with valve closures, but turbulent
          umes for the right and left ventricles are   blood flow and vibrations of large vessels
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