Systole ( SIST-ə-lee) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. Its contrasting phase is diastole, the relaxed phase of the cardiac cycle when the chambers of the heart are refilling with blood.
Etymology The term originates, via Neo-Latin, from Ancient Greek συστολή (sustolē), from συστέλλειν (sustéllein 'to contract'; from σύν sun 'together' + στέλλειν stéllein 'to send'), and is similar to the use of the English term to squeeze.
Terminology, general explanation
The mammalian heart has four chambers: the left atrium above the left ventricle (lighter pink, see graphic), which two are connected through the mitral (or bicuspid) valve; and the right atrium above the right ventricle (lighter blue), connected through the tricuspid valve. The atria are the receiving blood chambers for the circulation of blood and the ventricles are the discharging chambers. In late ventricular diastole, the atrial chambers contract and send blood to the ventricles. This flow fills the ventricles with blood, and the resulting pressure closes the valves to the atria. The ventricles now perform isovolumetric contraction, which is contraction while all valves are closed. This contraction ends the first stage of systole. The second stage proceeds immediately, pumping oxygenated blood from the left ventricle through the aortic valve and aorta to all body systems, and simultaneously pumping oxygen-poor blood from the right ventricle through the pulmonic valve and pulmonary artery to the lungs. Thus, the pairs of chambers (upper atria and lower ventricles) contract in alternating sequence to each other. First, atrial contraction feeds blood into the ventricles, then ventricular contraction pumps blood out of the heart to the body systems, including the lungs for resupply of oxygen. Cardiac systole is the contraction of the cardiac muscle in response to an electrochemical stimulus to the heart's cells (cardiomyocytes). Cardiac output is the volume of blood pumped by the ventricles in one minute. The ejection fraction is the volume of blood pumped divided by the total volume of blood in the left ventricle.
Types of systole
Atrial systole
Atrial systole occurs late in ventricular diastole and represents the contraction of myocardium of the left and right atria. The sharp decrease in ventricular pressure that occurs during ventricular diastole allows the atrioventricular valves (or mitral and tricuspid valves) to open and causes the contents of the atria to empty into the ventricles. The atrioventricular valves remain open while the aortic and pulmonary valves remain closed because the pressure gradient between the atrium and ventricle is preserved during late ventricular diastole. Atrial contraction confers a minor-fraction addition to ventricular filling, but becomes significant in left ventricular hypertrophy, or thickening of the heart wall, as the ventricle does not fully relax during its diastole. Loss of normal electrical conduction in the heart—as seen during atrial fibrillation, atrial flutter, and complete heart block—may eliminate atrial systole completely. Contraction of the atria follows depolarization, represented by the P wave of the ECG. As both atrial chambers contract—from the superior region of the atria toward the atrioventricular septum—pressure rises within the atria and blood is pumped into the ventricles through the open atrioventricular valves. At the start of atrial systole, during ventricular diastole, the ventricles are normally filled to about 70–80 percent of capacity by inflow from the atria. Atrial contraction also referred to as the "atrial kick," contributes the remaining 20–30 percent of ventricular filling. Atrial systole lasts approximately 100 ms and ends prior to ventricular systole, as the atrial muscle returns to diastole. The two ventricles are isolated electrically and histologically (tissue-wise) from the two atrial chambers by electrically impermeable collagen layers of connective tissue known as the cardiac skeleton. The cardiac skeleton is made of dense connective tissue which gives structure to the heart by forming the atrioventricular septum—which separates the atria from the ventricles—and the fibrous rings which serve as bases for the four heart valves. Collagen extensions from the valve rings seal and limit electrical activity of the atria from influencing electrical pathways that cross the ventricles. These electrical pathways contain the sinoatrial node, the atrioventricular node, and the Purkinje fibers. (Exceptions such as accessory pathways may occur in this firewall between atrial and ventricular electrical influence but are rare.) Cardiac rate control via pharmacology is common today; for example, the therapeutic use of digoxin, beta adrenoceptor antagonists, or calcium channel blockers are important historical interventions in this condition. Notably, individuals prone to hypercoagulability (abnormality of blood coagulation) are at decided risk of blood clotting, a very serious pathology requiring therapy for life with an anticoagulant if it cannot be corrected.
Right and left atrial systoles The atrial chambers each contains one valve: the tricuspid valve in the right atrium opens into the right ventricle, and the mitral (or bicuspid) valve in the left atrium opens into the left ventricle. Both valves are pressed open during the late stages of ventricular diastole; see Wiggers diagram at the P/QRS phase (at right margin). Then the contractions of atrial systole cause the right ventricle to fill with oxygen-depleted blood through the tricuspid valve. When the right atrium is emptied—or prematurely closed—right atrial systole ends, and this stage signals the end of ventricular diastole and the beginning of ventricular systole (see Wiggers diagram). The time variable for the right systolic cycle is measured from (tricuspid) valve-open to valve-closed. The contractions of atrial systole fill the left ventricle with oxygen-enriched blood through the mitral valve; when the left atrium is emptied or closed, left atrial systole is ended and ventricular systole is about to begin. The time variable for the left systolic cycle is measured from (mitral) valve-open to valve-closed.
Atrial fibrillation
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![Systole: 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.[2]](https://upload.wikimedia.org/wikipedia/commons/thumb/b/b0/QRS_normal.svg/960px-QRS_normal.svg.png?utm_source=en.wikipedia.org&utm_campaign=parser&utm_content=thumbnail)


