Cardiac output

Prof Anura Weerasinghe

Objectives

Factors regulating cardiac output

Measurement of cardiac output
Cardiac indices
Changes in cardiac output under
Physiological conditions
Pathological situations

Correlation of cardiac events in the genesis

of cardiac output

Cardiac output
The output of the heart per unit time.
In a resting, supine man, about 5L/min
Stroke volume

Heart rate
72/min

(Amount of blood
pumped out of each ventricle
per beat.)

70 mL

CO = SV x HR

Factors affecting the cardiac

output
Factors affecting the stroke volume
Factors affecting the heart rate

Factors affecting stroke volume

Degree of ventricular filling during diastole

Rapid filling phase
Slow filling phase
Filling due to atrial systole (about 1/3)
Preload is the end-diastolic pressure when the
ventricle has filled.

Contractility of ventricles
Inotropic action of catecholamines

Resistance offered to ventricular pumping

action. (Afterload)
The afterload in the ventricle is the pressure in
the artery leading from the ventricle.

Preload and Afterload

Preload
The degree of tension of the muscle when it
begins to contract.
End-diastolic pressure when the ventricle has
filled.

Afterload
The load against which the muscle exerts it
contractile force.
The afterload in the ventricle is the pressure in
the artery leading from the ventricle.

Factors affecting heart rate

HR is predominantly under neurohumoral
influence.
Parasympathetic stimulation reduces HR.
Sympathetic stimulation or release of
catecholamines from the adrenal medulla
increase HR. (Chronotropic action)

Factors controlling cardiac output

Cardiac rate
Increased by sympathetic activation
(Chronotropic action)
Decreased by parasympathetic activation

Stroke volume
Sympathetic activation increases
positive inotropic action
Increased venous return due to
venoconstriction

Self-assessment questions
Define cardiac output
state the relation of cardiac output to stroke
volume and heart rate.
State the factors affecting the cardiac output

Starlings law of the heart

Energy of contraction is proportional to the

initial length of the cardiac muscle fibre.
The greater the stretch of heart muscle
during filling, the greater the force of
contraction and the greater the quantity of
blood pumped into the aorta.
Within physiological limits, the heart
pumps all the blood that comes to it without
allowing excessive damming of blood in the
veins.
After a point the tension declines as stretch
becomes more extreme.

Factors affecting the length of

cardiac muscle fibres
Increase
Strong atrial contraction
Increased total blood volume
Increased venous return
Pumping action of the skeletal muscle

Decrease
Standing
Increased intrapericardial pressure
Cardiac tamponade

Decreased ventricular compliance

Factors affecting the length of cardiac

muscle fibres regulate the end-diastolic
volume of the heart.
- Diastolic function
Systolic contraction regulates
end-systolic volume
- systolic function
Stroke volume = EDV ESV
70ml
= 110 - 40

Ejection fraction
The fraction of the end-diastolic volume
that is ejected is called the ejection fraction.
SV x 100
EDV
About 60%
Can be measured by Echocardiography.

Volume-pressure diagram of the

left ventricle

Pressure(mm Hg)

III

100
IV

I period of filling
II period of isometric
contraction
III period of ejection
IV period of isometric
II
relaxation

50

130

Volume(ml)

Pressure-volume loop of the left

ventricle
A End-diastolic volume
- Preload
B Afterload

Pressure(mm Hg)
C

C Aortic valve closes

- end systolic volume

100
A

D
50

130

Volume(ml)

Self-assessment questions
Draw a volume pressure diagram for
the right ventricle
Correlation of different events and aspects
of cardiac cycle
Ganong; pages 568 - 569 Guyton; page 99

Aortic
pressure
Atrial &
Ventricular
pressures
Ventricular
volume
ECG
Heart sounds

Cardiac output
Stroke volume

Heart rate
Diastolic function

Afterload

Systolic function

Measurement of cardiac output

using Ficks principle
Ficks Principle
The amount of substance taken up by an organ
(or by the whole body) per unit of time is equal
to the arterial level of the substance minus the
venous level (A-V difference) times the blood
flow
The amount of substance taken =
A V difference x Blood flow
Blood flow = amount of substance taken
A V difference

Cardiac Index
The output per minute per square
meter of body surface. (average 3.2L)
The correlation between resting cardiac output
and body surface.

Normal cardiac output curve

Normal cardiac output curve:

left ventricle
Left ventricular output is 5L/min when the
pressure in the right atrium is 2 mmHg.
When the atrial pressure rises between 4 8
mmHg, the left ventricular output increases
to about 13-14 L/min.
Further increase in right atrial pressure does
not increase the ventricular output and the
curve shows a plateau.

Normal cardiac output curve:

Right ventricle
Right ventricular output is 5 L/min when
the right atrial pressure is zero.
This reaches maximum when (i.e. 13 14
L/min) when the atrial pressure increases
between 2 4 mm Hg.

Effect of various conditions on

cardiac output

Increase

Anxiety and
excitement
Eating
Exercise
High environment
temperature
Pregnancy
Beriberi
Arteriovenous fistula
Hyperthyroidism
Anaemia

Ganong; 574 & 643

Decrease

Cardiac factors
Rapid arrhythmia
Heart disease
Peripheral factors
decreased venous
return
Decreased blood
volume
Acute venous
dilatation
Eg; fainting

No change in sleep

Guyton; 214

Cardiac performance during

exercise
Cardiac output l/min
HR
SV
ESV (ml)
EDV (ml)
Cycle time (s)
Ventricular systole
Ventricular diastole

Resting
5
70
70
75
145
0.85
0.3
0.55

Exercising
25
180
140
40
180
0.33
0.2
0.13

Circulatory adjustments during

exercise
Effects of mass sympathetic discharge
Increase in arterial pressure
Increase in cardiac output
Increased venous return

Guyton; page 224 - 226

Physiological basis for increased

cardiac output during exercise
Sympathetic activation
Inotropic and chronotropic
Together with

Increase venous return

The muscle pump and venocontriction
increase LVEDV
-----increase the initial length of ventricular
fibres (starlings law) increase CO

Self assessment questions

Describe Starlings law of the heart and its
limitations
Factors affecting the length of the cardiac
muscle fibres
Explain how Ficks principle is applied to
the measurement of cardiac output.
Define cardiac index
Explain the effect of various conditions on
cardiac output
Define preload, afterload, ejection fraction,
diastolic and systolic reserve volume and
the factors affecting them.

Self assessment questions

Review the effects of posture on
cardiovascular function
Reduction in cardiac output on standing from
lying position
Postural syncope

Objectives

Factors regulating cardiac output

Measurement of cardiac output
Cardiac indices
Changes in cardiac output under
Physiological conditions
Pathological situations

Correlation of cardiac events in the genesis

of cardiac output