Venous return

Flow of blood back to the heart

 Under steady-state conditions, venous return must equal cardiac output, when
averaged over time because the cardiovascular system is essentially a closed loop

 Otherwise, blood would accumulate in either the systemic or pulmonary circulations.

Although cardiac output and venous return are interdependent, each can be
independently regulated.

 The circulatory system is made up of two circulations (pulmonary and systemic)

situated in series between the (RV) and (LV). Balance is achieved, in large part, by
the F-S mechanism

 For example, if systemic venous return is suddenly increased (e.g., changing from
upright to supine position), right ventricular preload increases leading to an increase
in stroke volume and pulmonary blood flow

 The left ventricle experiences an increase in pulmonary venous return, which in turn
increases left ventricular preload and stroke volume by the Frank–Starling
mechanism. In this way, an increase in venous return can lead to a matched increase
in cardiac output

Factors of venous return

1. Skeletal muscle pump

1. While you are standing at rest, both the venous valve closer to the heart
(proximal valve) and the one farther from the heart (distal valve) in this
part of the leg are open, and blood flows upward toward the heart.

2. Contraction of leg muscles, such as when you stand on tip-toes or take

a step, compresses the vein. The compression pushes blood through the
proximal valve, an action called *milking (*skeletal muscle
contractions that drive venous blood toward the heart. At the same
time, the distal valve in the uncompressed segment of the vein closes
as some blood is pushed against it. People who are immobilized
through injury or disease lack these contractions of leg muscles. As a
result, their venous return is slower and they may develop circulation
problems
 3. Just after muscle relaxation, pressure falls in the previously
compressed section of vein, which causes the proximal valve to close.
The distal valve now opens because blood pressure in the foot is higher
than in the leg, and the vein fills with blood from the foot. The
proximal valve then reopens

2. Respiratory pump

1. During inhalation, the diaphragm moves downward, which causes a

decrease in pressure in the thoracic cavity and an increase in pressure
in the abdominal cavity

2. As a result, abdominal veins are compressed, and a greater volume of

blood moves from the compressed abdominal veins into the
decompressed thoracic veins and then into the right atrium

3. When the pressures reverse during exhalation, the valves in the veins
prevent backflow of blood from the thoracic veins to the abdominal
veins

4. Increasing the rate and depth of breathing is another way the body
raises cardiac output during physical exercise