Cardiac output

• It is the amount of blood pumped out by the left

ventricle into the aorta per minute
• Normal CO : 5 L/min (less in females, about 4-4.5 L/
min)

• Stroke volume: it is the amount of blood pumped by

the ventricle per heart beat
• Normal Stroke volume: 70 ml

• Cardiac output = Stroke volume X Heart rate

Variations in Cardiac output
• Physiological:
Age: CO increases after birth while body surface area
increases along with growth of the body. But CO
decreases in old age
Sex: less in females
Position change: CO decreases with change of posture
from lying to standing
Physical exercise: CO increases with exercise
Emotional excitement, anxiety etc increase CO
Variations in Cardiac output
• Pathological :
Fever CO increases
Hyperthyroidism

Severe hemorrhage
Shock CO decreases
Cardiac failure
Factors affecting Cardiac output
1. End diastolic volume

2. Venous return

3. Afterload acting on heart

4. Heart rate
1. End diastolic volume:
 EDV is the volume of blood remaining in the
ventricles at the end of diastole
 Normal EDV : 120 ml

 Frank Starling’s Law : “Force of contraction is

directly proportional to the initial length of muscle
fiber, within physiological limit”

 More the EDV more stretching on the muscles 

more force of contraction  more cardiac output
2. Venous Return :
o VR is the amount of blood returning from the great
veins into the right atrium per minute
o VR (At rest) : 5 L/min (equal to CO)
o After strenous exercise: may increase upto 35 L/min

o Increase in VR  increase in EDV  increase in

stroke volume  increase in CO

o Any factor increasing VR ultimately increases CO

Factors influencing Venous return:
Respiratory pump/intrathoracic pump : during
inspiration blood flow increases to the heart  due to
distension of thoracic veins by increased intrapleural
pressure and squeezing of abdominal veins into the
thoracic veins due to increased intra-abdominal
pressure

Muscle pump: during exercise

Venous tone : sympathetic stimulation 

vasoconstriction venous tone incresed  VR
increased
3. Afterload acting on the heart:
 Afterload is the load acting on muscle
after it starts contracting.
 No initial stretching of the muscle
 In heart: afterload is the resistance
against which the ventricles have to
pump out blood  it is the Peripheral
Resistance

 Cardiac output is inversely proportional

to Peripheral Resistance
4. Heart rate:
• Cardiac output is directly proportional to
Heart rate

• Any factor affecting HR directly affects

CO

• Normal HR : 60-100 beats/min, average

72 beats/min
• Tachycardia: HR > 100 beats/min
• Bradycardia: HR < 60 beats/min
• Bradycardia:
Physiological causes:
During sleep
Athlets

Pathological causes:
Hypothermia
Hypothyroidism
Heart attack