AL-Iraqia university

College of Medicine
Neurophysiology

Cardiovascular physiology
CVS
by
Dr. Mahasen Mohammed

Lec. 7
Patient having spinal cord
damage after car accident
leading to paralysis of both
lower limb with sever bleeding
an echo study done
compare his EF% at that time &
after 6 month from the accident
mention the physiology behind it
 Cardiac output
Objectives:
• Discus the factors that affects venous
return
• Discus the factors that affects cardiac
output.
• Describe how heart rate and stroke
volume interact to control cardiac output.
• state the influence of venous return on
cardiac output.
• Define the terms preload, and afterload.
Ejection Fraction (EF%)
Cardiac output(CO) the amount of blood
pumped by each ventricle per minute, expressed in
liters/minute. Normally, it is about 5 liters per
minute.

• CO = SV X HR
• Stroke volume = ( 70 ml/beat)
• Heart rate = 72 beat/minute
• If the HR = 72 beats/min., and the SV is
of 70 ml;
• Cardiac output = 72 X 70 = 5.04 Liters.
• As the cardiovascular system is a closed system.
• RV cardiac output= LV CO.
• young men CO= 5.6 liter/min.
• young women 10-20% less.
• The highest cardiac output recorded is 48
liters/min.
• cardiac output is not less than 5 liter / min. at rest
Blood volume is about 5 - 6 liters .
• So the heart pumps the whole blood in one minute.
 Control of cardiac
output
• Venous return (preload).
• Heart rate (HR)
• Myocardial contractility.
• Cardiac compliance.
• Afterload.
 I.Venous return (VR)

VR=CO
The CO is controlled by VR through:
• Frank-Starling law
• Direct effect of the venous return
on the heart rate through SA node
• Bainbridge reflex
 Pressure gradient for venous return
• pressure at the end
of capillaries.
•Right atrial pressure.
•Total blood
volumeVenous valves.
•Skeletal muscle pump
•Respiratory pump.
•Abdominal pump.
Cont. Pressure gradient for
venous return

• Inotropic state of
the heart, with the
effect of ventricular
contraction and
relaxation.
• Venomotor tone
with effect of vcc
state of tone of partial
vasocontraction
through α 1
receptores.
Decrease in Cardiac Output Caused
by Decreased Venous Return.
• 1. Decreased
blood volume.
Ex, hemorrhage
• 2. Acute
venous
dilation.
• 3. Obstruction
of the large
veins.
• 4. Decreased tissue mass,
especially decreased skeletal
muscle mass ; aging or
prolonged periods of physical
inactivity
II.Heart rate and cardiac
output

• In resting state, (the venous

return is constant), changes in
HR 100-200 beats/min., not
affect CO markedly.
• > 200 beats/minute reduce CO
• HR < 40 beats/minute reduce CO
Exercise & CO
cardiac output
1- sympathetic stimulation
i-increase in heart rate
ii-increased myocardial
contractility
2- increase in stroke volume by
increase in venous return by the
action of skeletal
III. Myocardial contractility

• It is the strength of contraction

at any given EDV.
• It exerts a major influence on
SV and in turn on CO.
• It is reduced in heart failure.
• It is measured by Ejection
Fraction
 Myocardial contractility is affected by :

I.Mechanical
The preload (i.e., EDV): controls the power of
cardiac contractility by Frank-Starling's law.
The afterload (i.e., aortic impedance)as in rise of
the arterial blood pressure, aortic stenosis or
polycythaemia).
II.Cardiac Ventricular hypertrophy; as in athletes
35 litres minute.
III. Extra cardiac Sympathetic nerve supply.
 CARDIAC COMPLIANCE:
∆V/∆P
It is the stretchability of myocardial
muscle
myocardial stiffness Cardiac
compliance
disease condition ex
Cadiomyopathies
pericardial effusion.
 Afterload
• It is the resistance that oppose
cardiac output.
• So increased afterload will reduce
cardiac output e.g., systolic
hypertension, aortic stenosis.
• Reduced total peripheral
resistance (reduced afterload)
causes high cardiac output.
Conditions that can
decrease the total
peripheral
resistance CO
Conditions that can decrease the
total peripheral resistance

1. Beriberi; thiamine deficiency

(vitamin B1)
2. Arteriovenous fistula (shunt,
also called an AV shunt
3. Hyperthyroidism
4. Anemia
 Summary
1- CO = SV X HR.
is 5.04 Liters.
2- EF reflects the CO and its
normally more than 55%
3-Venous return (preload).
Heart rate (HR)
Myocardial contractility.
Cardiac compliance.
Afterload. All affect CO
Answer the introductory
case