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At this point, the atrial systole applies contraction pressure to 'topping-off' the blood volumes sent to both ventricles; this atrial contraction closes the diastole immediately before the heart again begins contracting and ejecting blood from the ventricles (ventricular systole) to the aorta and arteries. [1] [2]
Diastole (/ d aɪ ˈ æ s t ə l i / dy-AST-ə-lee) is the relaxed phase of the cardiac cycle when the chambers of the heart are refilling with blood. The contrasting phase is systole when the heart chambers are contracting. Atrial diastole is the relaxing of the atria, and ventricular diastole the relaxing of the ventricles.
At the start of atrial systole, the ventricles are normally filled with approximately 70–80 percent of their capacity due to inflow during diastole. Atrial contraction, also referred to as the "atrial kick," contributes the remaining 20–30 percent of filling.
Electrical waves track a systole (a contraction) of the heart. The end-point of the P wave depolarization is the start-point of the atrial stage of systole. The ventricular stage of systole begins at the R peak of the QRS wave complex; the T wave indicates the end of ventricular contraction, after which ventricular relaxation (ventricular diastole) begins.
Atrial contraction rapidly follows, actively pumping about 30% of the returning blood. As diastole ends, the ventricles begin depolarizing and, while ventricular pressure starts to rise owing to contraction, the atrioventricular valves close in order to prevent backflow to the atria.
The sound occurs just after atrial contraction at the end of diastole and immediately before S1, producing a rhythm sometimes referred to as the "Tennessee" gallop where S4 represents the "Ten-" syllable. [2] It is best heard at the cardiac apex with the patient in the left lateral decubitus position and holding their breath.
The late phase is dependent upon atrial contraction and is therefore absent in patients with atrial fibrillation due to the lack of forceful atrial contraction, making the E/A ratio very large. [citation needed] The E/A ratio is a first generation test for diastolic performance of the heart. [citation needed]
During atrial systole, blood not only empties from the atria to the ventricles, but blood continues to flow uninterrupted from the veins right through the atria into the ventricles. (3) The atrial contractions must be gentle enough so that the force of contraction does not exert significant back pressure that would impede venous flow.
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