CARDIAC OUTPUT AND VENOUS

RETURN

MICHAEL F. HILL, Ph.D.

 LECTURE OBJECTIVES
1) Define venous return and how it differs from cardiac
output.
2) Diagram the normal venous return and cardiac output
curves.
3) Predict how the normal venous return and cardiac
output curves will be altered in response to inotropic
agents, changes in circulating blood volume, and
changes in TPR.
4) Describe the relationship between central venous
pressure and venous return.
5) Indicate how measures of central venous pressure can
be used to assess a patient’s circulatory status.
Fig. 4.26 Cardiac and vascular function curves.
Fig. 4.27 Effect of changes in stressed volume on mean systemic pressure.
Fig. 4.26 Cardiac and vascular function curves.
Fig. 4.28 Effects of positive inotropic agents (A) and negative inotropic agents (B) on
the cardiac and vascular function curves.
Fig. 4.29 Effects of increased blood volume (A) and decreased blood volume (B) on
the cardiac and vascular function curves.
Fig. 4.30 Effects of increased total peripheral resistance (TPR) (A) and decreased TPR
(B) on the cardiac and vascular function curves.
CENTRAL VENOUS PRESSURE (CVP)

• filling pressure of the right heart

• corresponds to the volume of blood enclosed

by the right atrium and great veins in thorax
PERIPHERAL VENOUS PRESSURE (PVP)

• pressure of the peripheral vascular beds

• corresponds to the volume of blood enclosed

by peripheral vascular beds
(A) Factors influencing venous return.
Source: Chapter 8. Central Venous Pressure: An Indicator of Circulatory Hemodynamics, Cardiovascular Physiology, 7e
Citation: Mohrman DE, Heller LJ. Cardiovascular Physiology, 7e; 2010 Available at:
http://accessmedicine.mhmedical.com/Content.aspx?bookId=357&sectionId=40134606 Accessed: May 04, 2017
Copyright © 2017 McGraw-Hill Education. All rights reserved
 KEY CONCEPT

Pressure Difference Between the Peripheral and

Central Venous Blood Pools Determines Venous
Return!
 DETECTING ABNORMAL CVP

• catheter-measured (Invasive)

• external jugular vein examination (Non-

Invasive)
 SUMMARY OF KEY CONCEPTS

• Cardiac output and venous return must be

equal in the steady state

• Inotropic agents alter the cardiac function

curve but the vascular function curve is
unaffected
 SUMMARY OF KEY CONCEPTS (Cont’d)

• Changes in blood volume alter the

vascular function curve but the cardiac
function curve is unaffected

• Changes in TPR alter both the vascular

function and cardiac function curves
 SAMPLE PROBLEM

In a steady state, venous return will be greater than

cardiac output when

A) PVP is higher than normal

B) Blood volume is higher than normal
C) Cardiac sympathetic nerve activity is lower than
normal
D) All the above
E) None of the above
10. The figure below shows pressure-volume loops for two situations.

CLINICAL PHYSIOLOGY CASE

An 83-year-old male presents with dyspnea, elevated CVP (as

evidenced by distension of external jugular veins), and a chest
radiograph demonstrating pulmonary edema. A diagnosis of
congestive heart failure is considered. Which of the following
approaches might a physician logically pursue in an attempt to
lower this patient’s CVP?

A) Increase preload
B) Increase afterload
C) Increase circulating blood volume
D) Decrease preload
E) Increase venous tone
 RELEVANCE TO ORO-FACIAL CARE

Patients with a history of heart failure who

undergo prolonged dental procedures are at
increased risk for acute decompensated heart
failure and concomitant elevations in their CVP.
 RELEVANCE TO ORO-FACIAL CARE

Since CVP provides clinically relevant

information about a patient’s circulatory status
and can be approximated non-invasively by
noting the fullness of a patient’s jugular veins,
monitoring of neck vein distention is of
diagnostic value in detecting worsening heart
failure during their dental procedures.