Cardiac Output

Prof. K. Sivapalan

2013 Cardiac output 1

 Cardiac output.
• Stroke volume:- volume of blood pumped in one
beat.
• SV = End diastolic volume – End systolic
volume.
• Ejection fraction
= stroke volume / end diastolic volume x 100 = 65 %.
• Heart rate :- number of heart beats per minute.
• Cardiac output is the volume of blood pumped
by each ventricle in one minute.
• CO is equal for both ventricles but stroke volume
could vary between ventricles.

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 Measurement of cardiac output.
• Cut aorta and collect blood
– not accurate, not possible.
• Dilution method.
– Indocyanine green-dye
– Cold water.
• Inject dye or cold water into vein and monitor the concentration in
arterial blood. The dye enters right heart, pulmonary circulation, left
heart and into peripheral circulation.
– The concentration increases rapidly and declines because of washing
out from cardiac chambers, and starts rising again as it returns for the
second time.
– Extrapolate the decline to calculate average concentration [assuming
all blood is collected]
• Flow in measured time = amount injected divided by average
concentration [or temperature].
• Fick principle:
– Output = O2 consumed [mL/min] divided by difference between arterial
and venous blood [mL/min].
• Echocardiogram

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 Cardiac index.
• Cardiac index = cardiac output per minute
per square meter body surface.
• 3.2 L / min / M2.
• Useful to compare individuals.

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 Factors affecting C.O.
Cardiac output depends on,
 Venous return [Frank Starling law].
Benefit for transplant patients.
 Heart rate [ventricular filling].
 Catecholamines [force of contraction].
Within physiological range,
cardiac out put is not affected by
peripheral resistance.
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 Cardiac metabolism.
• Oxygen consumption [metabolism] of
– myocardium (stopped)- 2 ml / 100 g / min.
– skeletal muscle 0.2 ml / 100 g / min.
– Beating heart at rest- 9 ml / 100 g / min.
• Energy requirement depends on,
– Heart rate
– Intra myocardial tension
– Contractile state of myocardium
• Intra myocardial tension [wall] generates intra
cardiac pressure according to the law of
Laplace.

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 Intra mural pressure and wall
tension.

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Contractile state of myocardium.
• Sympathetic and parasympathetic
impulses.
• Circulating catecholamines..
• Hypoxia, hypercapnoea, acidosis.
• Loss of myocardium.
• Drugs- depressants and stimulants.
• Intrinsic depression.

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 Cardiac work.
• In heart, P = TW/r
– [P- pressure, T-tension, W- thickness, r- radius.]
• When pressure is same and radius increased, tension also
increased. – disadvantage in cardiac dilatation.
• But increase in thickness is beneficial.
• Mechanical work per beat:
=QR + MV2 / 2G [G = 9.8 g.m.]
(Q-Stroke volume, R- Mean arterial pressure, M- mass of blood
pumped, V- mean velocity in aorta.
• R in systemic circulation is 7 times more than in pulmonary
circulation.
• Increase in pressure work [after load] causes higher increase in
oxygen consumption than with volume work [preload].

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