DESCRIBE THE FACTORS AFFECTING
CARDIAC OUTPUT.
BY:
DISHA PRAKASH
I MBBS, ROLL NO: 16M069
OBJECTIVES OF LEARNING
Terminology and conceptual understanding of Cardiac Output.
Factors regulating Cardiac Output.
Measurement of Cardiac Output.
ABSTRACT
The goal of cardiac system is to maintain adequate blood flow to all tissues of the
body. The heart works in conjugation with cardiovascular centres and peripheral
blood vessels to achieve the goals.
Figure 1: Cardiovascular System
TERMINOLOGIES
CARDIAC OUTPUT
Cardiac output is the volume of blood pumped by heart each minute.
It is product of heart rate and stroke volume and averages about 5.25L/min.
Cardiac output = Heart Rate X Stroke Volume
Heart Rate = number of beats per minute.
Stroke volume =amount of blood ejected in each beat.
VENOUS RETURN
Venous Return is defined as quantity of blood flowing from the veins into the right atrium
per minute.
In steady state, the heart pumps blood at the same rate at which blood enters the heart.
Cardiac Output (CO) =Venous Return (VR)
For the normal heart, CO is largely determined by events in peripheral circulation thus
venous return derives cardiac output.
Figure 2: Venous Return
FACTORS REGULATING CARDIAC OUTPUT
1. The key factor regulating stroke volume is the amount of stretching that occurs to
ventricular wall prior to ventricular contraction. The more cardiac muscle stretches,
the more forcefully it contracts. These stronger contractions increase stroke volume.
Since,
Cardiac Output (CO) Stroke Volume (SV)
2. Increase in Heart Rate also increases the cardiac output as; Cardiac output is directly
proportional to the Heart rate.
Various factors like exercise, rise in body temperature, drugs like Caffeine, emotional
or physical exertion, dehydration increases heart rate, indirectly increasing the
cardiac output.
Figure 3: Factors affecting cardiac output
3. Increase in Sympathetic response in case of Fight-and-Flight situation increases the
heart rate hence increases the cardiac output also decrease in parasympathetic
response decreases the cardiac output.
4. Increase in Venous Return increases the End Diastolic Volume thus increasing stroke
volume with the cardiac output. Factors affecting EDV:
* The duration of ventricular diastole.
* Venous return
When HR increases, the duration of diastole is shorter. Less filling means a smaller
EDV. When venous return increases, a greater volume of blood flows into the ventricles and
EDV is increased. SV is directly proportional to EDV thus cardiac output increases.
Figure 4: Controlling factors of Cardiac Output
FRANK-STARLING MECHANISM
• Increased venous return increases the ventricular filling (end-diastolic volume) and
therefore preload.
• Myocyte stretching increases the sarcomere length.
• The myocardial fibres are stretched; the force of contraction is increased.
• The length of the fibre is determined primarily by the volume of blood in the ventricle,
thus EDV is the primary determinant of preload
• This mechanism enables the heart to eject the additional venous return, thereby
increasing stroke volume, thus cardiac output.
Figure 5: Frank-Starling Mechanism Figure 5.1: Frank-Starling Curves
Increase in venous return to the left ventricle Changes in the afterload and inotropy shift the
And increases LVEDP thereby increases curve up or down.
the volume and stroke volume.
FICKS’ PRINCPLE: MEASUREMENT OF CARDIAC OUTPUT
Figure 6: Ficks’ Principle
O2 absorbed per minute by the lung (mL/min)
CO =
Arteriovenous O2 difference (mL/L of Blood)
REFERENCES
Cardiac Output, www.interactivephysiology.com
Cardiac Output and Its Regulation, www.duhs.edu.pk
Google Images (Source of Images)
Medical Physiology, Guyton & Hall, 12th Edition, Page 229-231
Thank You.
