Physiology (code)-year 2

Cardiovascular system
Lecture 7+8
(Cardiac output)

By Dr. Ahmed Badr

Physiology Department
College of Medicine
University of Basrah
The cardiac output (C.O.)

1) To define and calculate the cardiac output.

2) To identify different factors that modify the cardiac output.
Cardiac output
It is the volume of blood ejected from each
ventricle per minute
Cardiac output (CO)
= heart rate (HR) x stroke vol.(SV)
HR
number of heart beats per minute

SV
volume of blood ejected from each ventricle per one beat

Normal CO = heart rate (HR) x stroke vol.(SV)

= 72 B/ min × 70 ml
= 5040 ml/min= (about 5L/ min)
Regulation of C.O.:

CO

HR SV

ANS preload contractility afterload

 Factors affecting HR

+ve chronotropic effect -ve chronotropic effect

Sympathetic NS Parasymp NS
1 Preload
- Is the load before ventricular contraction
o
r
The tension exerted on the ventricular wall by the blood filling
at the end of diastole

It is determined by the EDV

ED
V The volume of blood in the ventricle at the end of diastole
↑ EDV ↑ ↑ in the ↑in tension ↑ stroke
stretching length during volume
of the wall of contraction
of the muscle
ventricles fibers

actin

myosin
 Frank-starling curve
Failing
point

St
ro End Diastolic Volume
k
Frank Starling’s Law of the Heart

Residu Stroke
al volume
EDV SV
contraction

Larger
EDV Stronger Large
contraction r
SV
Factors affecting venous return
Right atrial pressure

Total blood volume

Venoconstriction

Respiratory pump

skeletal Muscle pump

Gravity
Right atrial pressure

Normal right atrial pr about 3-8 mmHg

↑ right atrial pr →↓ Venous return

HF → ↓CO → ↑ → ↓ Venous return

C.V.P
skeletal Muscle
Respiratory pump
pump
Gravity
2 Myocardial contractility:
- it is the force & velocity with which the myocardium
fibers contract

It is also called the inotropic state of the myocardium

Factors
↑contractility
+ve
inotropic
effect
Factors
↓contractility
-ve inotropic
effect
 Factors with +ve
inotropic effect
Symp. Hormones Drugs
NS

Factors with -ve

inotropic effect

Parasymp. hypoxia, Diseases of Drugs

NS hypercapnia the cardiac
& acidosis muscle
Mechanism of action of digoxin
K digoxin N
a
K
N
a

N
a

Na-k Na-Ca
pump exchange
r

N
a

N
a C
a
N
a ↑Na ↑Ca
 Factors ↑ shifts the Frank-Starling
curve up and to the left
contractility
 10
0 ↑
contractility
shifts upward and to the
left shifts down and to the right

5
0
S ↓
contractility
V
(
0
m 1 2
0 0
l) LVEDP
3 afterload
-
Is the load that the heart must eject blood
against
o
r
the forces that oppose ejection of blood out of
the chamber

↑ ↓SV
afterload
↑ Arterial or pulm.
afterload hypertension
Aortic or pulm. valve
stenosis
 ↑ shifts the Frank-Starling
curve down and to the right
afterload
10
0 ↓
afterload
shifts upward and to the
left shifts down and to the right

5
0
S ↑
afterload
V
(
0
m 1 2
0 0
l) LVEDP
Measurement of C.O
Fick
method
O2 consumption = C.O × (Arterial O2 – venous O2)
C.O.= O2 consumption (ml/min)
Arterial O2 – venous O2
Ex: Calculate the CO (O2 consumption = 250ml/min,
arterial O2 = 190 ml/l and venous O2= 140 ml/l)

C.O.= 250ml/min
190 ml/l -140 ml/l

C.O.= 250ml/min = 5 L/min.

50 ml/l
Cardiac
index
Is the C.O. correlated to the surface area of
the body
C.I. (L/m2/min) = C.O
S.A