Regulation of Cardiac Output and Venous Return by Dr. Roomi
Regulation of Cardiac Output and Venous Return by Dr. Roomi
CARDIAC OUTPUT
CARDIAC OUTPUT (CO): Quantity of blood pumped into the aorta each minute by the heart. In a resting supine man, it is 5L/min
C.O = Law)
(Ohms
EJECTION FRACTION: is the fraction of EDV that is ejected out by each ventricle per beat. Normally it is 60-65%.
CARDIAC INDEX: It is the correlation between resting C.O & body surface area. C.I = C.O / min / m2 of body surface 70kg man has body surface area = 1.7 m2 So, C.I = 5L/min = 3L / min / m2 (approx) 1.7m2
CARDIAC RESERVE: is the maximum amount of blood that can be pumped out by the heart above normal value. SIGNIFICANCE: In normal persons, C.O increases during stress like exercise. C.R = 300-400% (in young adult) C.R = 200-250% (in old age) C.R = 500-600% (in athletes) C.R = 0% approx (in cardiac diseases)
VENOUS RETURN is the quantity of blood flowing from the veins into the right atrium each minute. Normally V.R = C.O (Frank starling law)
PHYSIOLOGICAL FACTORS
1. AGE:
CHILDREN = less C.O (due to low B.Vol) & C.I of children >C.I of adults (due to less body surface area). OLD AGE = less C.O (due to low metabolic activity). In FEMALES: C.O = less, C.I = more (due to less surface area) In MALES: C.O = more, C.I = less (due to more body surface area)
C.O is more if body build is greater
2. SEX:
3. BODY BUILD:
C.O = low in morning (due to low BMR) C.O = more in day time (due to high
BMR)
5. TEMPERATURE:
C.O = increases if temp increases above 30C. C.O = increases by 50-100% in Anxiety & excitement. Mechanism: Release of CATS increased H.Rate & Force of contraction.
6. EMOTIONAL CONDITIONS:
8. EXERCISE:
9. HIGH ALTITUDE:
C.O = decreases when recumbent upright position. MECHANISM: Pooling of blood in lower limbs, when we stand up from lying position. C.O = increased by 45-60% in later months of pregnancy.
C.O = reduced / unchanged during sleep.
11. PREGNANCY:
12. SLEEP:
PATHOLOGICAL FACTORS:
1. PYREXIA / FEVER:
2. ANEMIA:
CCF: C.O is less (due to weak contraction of heart). SHOCK: C.O = less (due to poor pumping & circulation). HEMORRHAGE: C.O = less (due to low blood volume).
REGULATION OF C.O:
C.O = STROKE VOL. X HEART RATE C.O REGULATING FACTORS INCLUDE:
Most important factor. Amount of blood which returns to heart/min. Basic factors affecting V.R:
V.R = ARTERIAL B.P TPR V.R = MEAN SYSTEMIC FILLING Pr Rt. At. Pr RESISTANCE TO V.R V.R = MSFP-RAP RVR
2. MSFP:
Mean Systemic Filling Pressure is average pressure in systemic blood vessels which tends to push the blood towards the heart, when there is no active circulation. It indicates the degree of filling of blood vessels. MSFP depends on:
Normal MSFP = 7mmHg (MCQ) MSFP is affected by blood volume, sympathetic Stimulation & contraction of skeletal muscles. (Directly proportional)
More Blood Volume more MSFP more V.R (in blood loss low B.V low V.R) Symp. StimULATION VenoConstriction more V.R Skeletal muscle contraction more MSFP more V.R
RIGHT ATRIAL PRESSURE = C.V.P = 0 in most of Cardiac Cycle. RVR (RESISTANCE TO V.R) is resistance offered by veins against the return of blood = 1.4mmHg/L So V.R = MSFP-RAP RVR V.R = 7-0 = 5L 1.4
Effect of hormones & drugs etc which increase C.O: (by increaseing contraction of heart)
1. 2. 3. 4. 5. 6. 7. 8.
Cats Thyroxine Glucagon Increased temperature Caffeine Theophylline Digitalis Calcium ions
EDV
ESV
AFTER LOAD ART. Pr
CARDIAC CONTRACTILITY
MSFP
CARDIAC NUTR NERVOUS STIM. DRUGS & MET SYMP ST SK MUS CONTR
Generally when H.R increases C.O increases. (but the limit is 150/min) Between 150-180 beats/min, there is no increase in C.O. Beyond 180-190 beats/min, C.O decreases, with increasing heart rate. It is because of too short diastole
Sympathetic Parasympathetic
SLOWING OF H.R.
Decrease force of contraction Only slight effect because vagal fibers do not supply ventricular muscle.
3) ve DROMOTROPIC EFFECT:
4) ve BATHMOTROPIC EFFECT:
2.
3.
4. 5.
6. 7. 8.
Coronary artery blockage, causing a heart attack Inhibition of sympathetic excitation of the heart Pathological factors that cause abnormal heart rhythm or rate of heartbeat Valvular heart disease Increased arterial pressure against which the heart must pump, such as in hypertension Congenital heart disease Myocarditis Cardiac hypoxia
Cardiac output curves at different levels of intrapleural pressure and at different degrees of cardiac tamponade
Venous Return
Definition: it is the quantity of blood flowing from the veins into the right atrium each minute. Normally V.R = C.O (Frank starling law)
VENOUS RETURN = (MEAN SYSTEMIC FILLING PRESSURE RIGHT ATRIAL PRESSURE)/ RESISTANCE TO VENOUS RETURN
Increase in MSFP shifts the VR curve to the right and vice versa.
Combinations of the major patterns of venous return curves, showing the effects of simultaneous changes in mean systemic filling pressure (Psf) and in resistance to venous return.