Cardiac Output

When the heart contracts

 Cardiac Vocabulary
• Contractility:  Contractility is the intrinsic
ability of cardiac muscle to develop force
for a given muscle length.
 Cardiac Vocabulary
• Preload:  Preload is the muscle length prior to
contractility, and it is dependent of ventricular
filling (or end diastolic volume…EDV) 

• This value is related to right atrial pressure.

 
• The most important determining factor for preload
is venous return.
 Cardiac Vocabulary
• Afterload:  Afterload is the tension (or the arterial
pressure) against which the ventricle must contract. 

• If arterial pressure increases, afterload also increases.

• Afterload for the left ventricle is determined by aortic

pressure

• Afterload for the right ventricle is determined by

pulmonary artery pressure.
Cardiac Output

Cardiac Output is the volume of blood pumped

each minute, and is expressed by the following
equation:
• CO = SV x HR
• Where:
• CO is cardiac output expressed in L/min (normal
~5 L/min)
• SV is stroke volume per beat
• HR is the number of beats per minute
 Heart Rate (HR)
Heart rate is directly proportional to cardiac output

• Adult HR is normally 80-100 beats per minute (bpm.) 

• Heart rate is modified by autonomic, immune, and local factors.  For

example:

1. An increase in parasympathetic activity via M2 cholinergic receptors in

the heart will decrease the heart rate.

2. An increase in sympathetic activity via B1 and B2 adrenergic receptors

throughout the heart will increase the heart rate.
 Stroke Volume (SV)
SV = EDV - ESV
• Is determined by three factors: preload, afterload, and contractility. 

• Preload gives the volume of blood that the ventricle has available to
pump

• Contractility is the force that the muscle can create at the given length

• Afterload is the arterial pressure against which the muscle will

contract.
 
• These factors establish the volume of blood pumped with each heart
beat. 
Preload
afterload
Cardiac Volumes
• SV = end diastolic volume (EDV) - end
systolic volume (ESV)

• EDV = amount of blood collected in a

ventricle during diastole

• ESV = amount of blood remaining in a

ventricle after contraction
 Cardiac Reserve
• Cardiac reserve is the difference between
resting and maximal CO

• Cardiac Output: Example

CO (ml/min) = HR (75 beats/min) x SV (70
ml/beat)

• CO = 5250 ml/min (5.25 L/min)

 Frank – Starling Principle
• This principle illustrates the relationship between
cardiac output and left ventricular end diastolic
volume (or the relationship between stroke volume
and right atrial pressure.)
 Frank – Starling Principle
• The Frank Starling principle is based on the length-tension
relationship within the ventricle.

• If ventricular end diastolic volume (preload) is increased, it follows

that the ventricular fiber length is also increased, resulting in an
increased ‘tension’ of the muscle.

• Cardiac output is directly related to venous return, the most

important determining factor is preload. 

• The contraction and therefore stroke volume in response to changes

in venous return is called the Frank-Starling mechanism (or
Starling's Law of the heart).
How (TPR)Total Peripheral
Resistance effects CO
 Regulation of Heart Rate: Autonomic
Nervous System
• Sympathetic nervous system (SNS) stimulation is activated by
stress, anxiety, excitement, or exercise

• Parasympathetic nervous system (PNS) stimulation is mediated

by acetylcholine and opposes the SNS
slowing heart rate

• Baroreceptors
         a. carotid sinus reflex - maintains BP in brain
• b. Bainbridge reflex – maintains BP in heart
• c. Aortic sinus reflex – maintains BP in aorta
Bainbridge Reflex
• Bainbridge (atrial) reflex – a sympathetic
reflex initiated by increased blood in the
atria

• Causes stimulation of the SA node

• Stimulates baroreceptors in the atria,

causing increased SNS stimulation
 Cardiac
Neurotransmitters
& Receptors
 Chemical Regulation
of the Heart
• The hormones epinephrine and thyroxine (T4)
increase heart rate

• Hormonal Regulation of Blood Pressure

      1. Renin
      2. ADH
3. Aldosterone

• Intra- & extracellular ion concentrations must be

maintained for normal heart function
 Homeostatic Imbalances
• Hypocalcemia – reduced ionic calcium depresses the
heart

• Hypercalcemia – dramatically increases heart irritability

and leads to spastic contractions

• Hypernatremia – blocks heart contraction by inhibiting

ionic calcium transport

• Hyperkalemia – leads to heart block and cardiac arrest

 Congestive Heart Failure (CHF)
caused by:
• Coronary atherosclerosis

• Increased blood pressure in aorta

• Successive myocardial infarcts

• Dilated cardiomyopathy (DCM)

Coronary
Artery
Bypass
Surgery
Heart Auscultation

Aortic
Stenosis

Normal
Diastolic Mid Systolic Heart
Murmur Click Beat