Cardiac Output Measurement

By,
Antony Rajan
Introduction….

• Quantity of blood delivered by heart into

aorta per min..

• determinant of oxygen supply to the

tissues..

• Reduction of this will results in low bp,

reduced tissue oxygenation, poor renal
function, etc..
Contd…
• It is the reflection of myocardial
function..

• normal 4 – 6 L/min..

• stroke volume & HR

Introduction to Methods…

• Direct Method..
using electromagnetic flow probe placed on aorta ….
(CO = SV*HR)..

• Flick method…

CO = VO2 / (Ca - Cv)

CO=Cardiac output,
VO2=Consumption of O2 by organ..
Ca and Cv are con of O2 in arterial and venous blood to
the organ
Indicator dilution

• Injection or removal of known amount of

indicator to a fluid…

• Measuring the conc difference measured

above or below from the injection side…

• Can estimate the volume flow of fluid…

Indicator Dilution Method…
• M quantity of injected indicator in mg

• Q=M/(avg con of indicator per litre * urve

duration
By US method….

• The velocity of blood is find out using us

(Doppler principle)..

• If we know or can measure the CSA of aorta

then..
Flow rate = Velocity * CSA ( vol / time )

• The obtained flow rate equals to cardiac output

minus blood to coronary artery

• This equation is over simplified one…

Contd….

• In the above eq. velocity is considered as

a const..

• But in aorta blood flow is pulsatile one…

• So here we measure SV…

SV = CSA * ∫ V(t) dt over VET

• SV multiplied with HR gives CO….

• Velocity calculated from Doppler eq....

V = ( C * Fd )/( 2F0 * Cos ǿ )

C = velocity of sound..
Fd = Frequency shift..
F0 = Frequency of emitted sound
ǿ = angle b/n emitted sound and
moving object
• For ascending aorta velocity is measured
by placing probe above the sternal
notch…

• In case descending probe used along with

esophageal stethoscope..

• CSA of aorta can be measured using

echo.. or from nomograms..
• Deltex medical , USA developed a quick
and continues SV and CO measurement
using Esophageal US Doppler instrument..

• System works on 4MHz frequency probe..

• Measured the left ventricular

performance…
Disadvantages..

• Lack of precise measurement of CSA of

aorta..

• Comparison with std indicator dilution

method the correlation coefficient ranges
from .63 to .91
Impedance technique
• R = ρL / A
is the resistance b/n two electrodes placed in
thorax

• With each ejection of SV dV , the resistace

decresed by dZ, given as..
dV = - ρ [L/Z0]^2 dZ

dZ is change in Z0 w.r.t dV
• dV = - ρ [L/Z0]^2 * T [ dZ/dt]max

T is time interval b/n dZ/dt = 0 and second heart

sound…

[dZ/dt]max peak value of dZ/dt during systole..

ρ normal value is 150 ohm m

basal impedance Z0 is found to be 25 ohm

• Instrumentation …

 100khz signal…b/n 1 and 4 electrodes..

 electrode 2 and 3 picks the modulated

signal..

 amplified and demodulated to differentiator..

 differentiator for dZ/dt…

 records the value from differentiator and

phonocardiogram…. To find ‘T’
• About the method…

 Monitoring each SV non-invasively…

 But correlation to dye dilution method, its not

acceptable…

 Problem of accuracy…