CARDIAC OUTPUT AND

ITS CONTROL

Made by:
DR. ZARA BATOOL
CARDIAC OUTPUT
• It is the quantity of blood pumped by the heart into aorta per minute.
• Normal value of cardiac output for a normal man is 5.6 L/min and for
a woman is 5 L/min.
• The quantity of blood returning to heart each minute is called venous
return.
• Cardiac output per square meter of body surface area is called cardiac
index.
• Cardiac index of a normal healthy human weighing 70 kg with a body
surface area of 1.7 square meter is 3 L/min/m2
Factors affecting cardiac output
• Level of body metabolism
• Level of activity
• Age
• Size of body
 CONTROL OF CARDIAC OUTPUT
• Primary controller of cardiac output is venous return.
• Heart has a built-in mechanism that normally allows it to pump
automatically whatever amount of blood that flows into the right
atrium from the veins.
• This mechanism, called the Frank-Starling law of the heart.
• When increased quantities of blood flow into the heart, the increased
blood stretches the walls of the heart chambers.
• As a result of the stretch, the cardiac muscle contracts with increased
force, and this empties the extra blood that has entered from the
systemic circulation.
• Another important factor is that stretching the heart causes the heart
to pump faster, at an increased heart rate.
• Stretch of the sinus node in the wall of the right atrium has a direct
effect on the rhythmicity of the node itself to increase heart rate as
much as 10 to 15 per cent.
• Another mechanism by which heart rate can be increased is BRAIN
BRIDGE reflex.

• Stretching of the right atrium send signals to vasomotor center

which then send sympathetic signals through sympathetic nerves and
vagus nerves to increase heart rate.
Cardiac Output Regulation
• The venous return to the heart is the sum of all the local blood flows
through all the individual tissue segments of the peripheral circulation.

• All the local blood flows summate to form the venous return, and the
heart automatically pumps this returning blood back into the arteries to
flow around the system again.
Effect of Total Peripheral Resistance on the
Long-Term Cardiac Output Level.
Heart limits for excessive cardiac output
• There are definite limits to the amount of blood that the heart can
pump, which can be expressed quantitatively in the form of cardiac
output curves.

• The normal human heart, functioning without any special stimulation,

can pump an amount of venous return up to about 2.5 times the
normal venous return before the heart becomes a limiting factor in the
control of cardiac output.
Factors That Can Cause Hypereffective Heart
1. Nervous stimulation
1. Increases the heart rate
2. Increases the strength of heart contraction
2. Hypertrophy of heart muscles
Factors That Cause a Hypoeffective Heart
1. Coronary artery blockage, causing a “heart attack”
2. Inhibition of nervous excitation of the heart
3. Pathological factors that cause abnormal heart rhythm or rate of
heartbeat
4. Valvular heart disease
5. Increased arterial pressure against which the heart must pump, such
as in hypertension
6. Congenital heart disease
7. Myocarditis
8. Cardiac hypoxia
Role of the Nervous System in Controlling
Cardiac Output
PATHOLOGICALLY HIGH CARDIAC
OUTPUTS
• Extremely high cardiac output results from greatly reduced
peripheral resistance that will increase the venous return.
• Some conditions that can increase cardiac output include:
1. Beri beri
2. Atriovenous fistula
3. Hyperthyroidism
4. Anemia
PATHOLOGICALLY LOW CARDIAC
OUTPUTS
• This results from either:
1. those abnormalities that cause the pumping effectiveness of the heart to fall
too low
2. those that cause venous return to fall too low.
Decreased Cardiac Output Caused by Cardiac
Factors.
• Whenever the heart becomes severely damaged, regardless of the
cause, its limited level of pumping may fall below that needed for
adequate blood flow to the tissues.
• Some examples of this include:
I. Coronary artery blockage
II. Myocardial infarction
III. Valvular heart disease
IV. Myocarditis
V. Cardiac temponade etc.
Decrease in Cardiac Output Caused by Non-
cardiac Peripheral Factors
• Decreased blood volume
• Acute venous dilation
• Obstruction of large veins
• Decreased tissue mass
Effect of blood volume on cardiac output
• A sudden increase in blood volume of about 20 per cent increases the
cardiac output to about 2.5 to 3 times normal
Thank you 