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Cardiac Output
Introduction
08-01-2020 Jaideep J Rayapudi, DMWIMS
1
Cardiac Output
Cardiac output is the
quantity of blood pumped
into the aorta each minute
by the heart.
08-01-2020 Jaideep J Rayapudi, DMWIMS
2
Venous return
The quantity of blood
flowing from the veins
into the right atrium
each minute
08-01-2020 Jaideep J Rayapudi, DMWIMS
3
CO = VR
5 liters
08-01-2020 Jaideep J Rayapudi, DMWIMS
4
CO = SV x HR
08-01-2020 Jaideep J Rayapudi, DMWIMS
5
Factors affecting CO
(1) the basic
level of body
metabolism
(2) whether the
person is
exercising
(3) the person’s
age
(4) size of the
body.
08-01-2020 Jaideep J Rayapudi, DMWIMS
6
Cardiac Index
Cardiac output per
square meter of body
surface area
 3 L/min/m2 of body surface area
08-01-2020 Jaideep J Rayapudi, DMWIMS
7
Effect of Age on
Cardiac Output
08-01-2020 Jaideep J Rayapudi, DMWIMS
8
Intrinsic Regulation of
Heart Pumping
The Frank-Starling
Mechanism
08-01-2020 Jaideep J Rayapudi, DMWIMS
9
Frank- Starling mechanism of the heart
Intrinsic ability of the
heart to adapt to
increasing volumes of
inflowing blood
08-01-2020 Jaideep J Rayapudi, DMWIMS
10
Otto
Frank &
Ernest
Starling
08-01-2020 Jaideep J Rayapudi, DMWIMS
11
Within physiologic
limits, the heart pumps
all the blood that
returns to it by the way
of the veins
08-01-2020 Jaideep J Rayapudi, DMWIMS
12
08-01-2020 Jaideep J Rayapudi, DMWIMS
13
Explanation of the Frank-Starling Mechanism
When an extra amount of blood
flows into the ventricles, the cardiac
muscle itself is stretched to greater
length
08-01-2020 Jaideep J Rayapudi, DMWIMS
14
Bainbridge reflex
The Bainbridge reflex, also called the
atrial reflex, is an increase in heart rate
due to an increase in central venous
pressure. Increased blood volume is
detected by stretch receptors
(baroreceptors) located in both atria at
the venoatrial junctions.
08-01-2020 Jaideep J Rayapudi, DMWIMS
15
Atrial natriuretic peptide
Powerful vasodilator
ANP acts to reduce the water, sodium and adipose
loads on the circulatory system, thereby reducing
blood pressure
08-01-2020 Jaideep J Rayapudi, DMWIMS
16
08-01-2020 Jaideep J Rayapudi, DMWIMS
18
Methods of
Measurement
08-01-2020 Jaideep J Rayapudi, DMWIMS
19
Measuring CO
Echocardiography & Doppler
Direct Fick method
Indicator Dilution Method
08-01-2020 Jaideep J Rayapudi, DMWIMS
20
Fick principle states that the amount of a
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
08-01-2020 Jaideep J Rayapudi, DMWIMS
21
Fick principle
Amount of marker substance taken up by the
organ per unit time
Concentration of marker substance in arterial
blood supplying the organ
Concentration of marker substance in venous
blood leaving the organ
08-01-2020 Jaideep J Rayapudi, DMWIMS
22
08-01-2020 Jaideep J Rayapudi, DMWIMS
23
INDICATOR DILUTION
TECHNIQUE08-01-2020 Jaideep J Rayapudi, DMWIMS
24
Factors Controlling
Cardiac Output
08-01-2020 Jaideep J Rayapudi, DMWIMS
25
08-01-2020 Jaideep J Rayapudi, DMWIMS
26
"I would urge, that a thorough study of
Human Physiology is, in itself, an
education broader and more
comprehensive than much that passes
under that name. There is no side of the
intellect which it does not call into play,
no region of human knowledge into which
either its roots, or its branches, do not
extend." — Thomas Henry Huxley
08-01-2020 Jaideep J Rayapudi, DMWIMS
27

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Cardiac output28102013

Editor's Notes

  1. Cardiac output is the quantity of blood pumped into the aorta each minute by the heart. This is also the quantity of blood that flows through the circulation. Cardiac output is perhaps the most important factor that we have to consider in relation to the circulation. Venous return is the quantity of blood flowing from the veins into the right atrium each minute. The venous return and the cardiac output must equal each other except for a few heartbeats at a time when blood is temporarily stored in or removed from the heart and lungs. Cardiac output is the quantity of blood pumped into the aorta each minute by the heart. This is also the quantity of blood that flows through the circulation. Cardiac output is perhaps the most important factor that we have to consider in relation to the circulation. Venous return is the quantity of blood flowing from the veins into the right atrium each minute. The venous return and the cardiac output must equal each other except for a few heartbeats at a time when blood is temporarily stored in or removed from the heart and lungs.
  2. For young, healthy men, resting cardiac output averages about 5.6 L/min. For women, this value is about 4.9 L/min.When one considers the factor of age as well—because with increasing age, body activity diminishes—the average cardiac output for the resting adult, in round numbers, is often stated to be almost exactly 5 L/min.
  3. Experiments have shown that the cardiac output increases approximately in proportion to the surface area of the body.Therefore, cardiac output is frequently stated in terms of the cardiac index, which is the cardiac output per square meter of body surface area. The normal human being weighing 70 kilograms has a body surface area of about 1.7 square meters, which means that the normal average cardiac index for adults is about 3 L/min/m2 of body surface area.
  4. the cardiac output, expressed as cardiac index, at different ages. Rising rapidly to a level greater than 4 L/min/m2 at age 10 years, the cardiac index declines to about 2.4 L/min/m2 at age 80 years. We will see later in the chapter that the cardiac output is regulated throughout life almost directly in proportion to the overall bodily metabolic activity. Therefore, the declining cardiac index is indicative of declining activity with age.
  5. In Chapter 20, we will learn that under most conditions, the amount of blood pumped by the heart each minute is determined almost entirely by the rate of blood flow into the heart from the veins, which is called venous return. That is, each peripheral tissue of the body controls its own local blood flow, and all the local tissue flows combine and return by way of the veins to the right atrium. The heart, in turn, automatically pumps this incoming blood into the arteries, so that it can flow around the circuit again.
  6. Frank- Starling mechanism of the heart, in honor of Frank and 112 Unit III The Heart Starling, two great physiologists of a century ago.
  7. Basically, the Frank-Starling mechanism means that the greater the heart muscle is stretched during filling, the greater is the force of contraction and the greater the quantity of blood pumped into the aorta.
  8. What Is the Explanation of the Frank-Starling Mechanism? When an extra amount of blood flows into the ventricles, the cardiac muscle itself is stretched to greater length. This in turn causes the muscle to contract with increased force because the actin and myosin filaments are brought to a more nearly optimal degree of overlap for force generation. Therefore, the ventricle, because of its increased pumping, automatically pumps the extra blood into the arteries. This ability of stretched muscle, up to
  9. Under most normal conditions, the long-term cardiac output level varies reciprocally with changes in total peripheral resistance.