CARDIAC OUTPUT

PRESENTED BY
N.PERUMAL BOT 4 TH YEAR
 Cardiac Output

• Amount of blood ejected by each ventricle per minute. It is the product of Stroke
volume(SV) and Heart rate(HR),
Cardiac Output = SV x HR
Normal value: 5L/Ventricle/minute.
• Cardiac output is the most important factor in cardiovascular system, because rate
of blood flow through different parts of the body depends upon cardiac output.
 STROKE VOLUME:
Stroke volume is the amount of blood pumped out by each ventricle during
each beat.
Normal Value: 70ml to 80ml.

Cardiac Index:
It is defined as the amount of blood pumped out per
ventricle/minute/square meter of the body surface area.
Normal Value: 3.2 L / Min/ Sq.meter of body surface area.
CO = SV x HR
cardiac output = stroke volume X
heart rate
(ml/minute) (ml/beat)
(beats/min)

1.Average heart rate = 70 bpm

2.Average stroke volume = 70−80 ml/beat
3.Average cardiac output = 5000 ml/minute
END DIASTOLIC VOLUME(EDV)
Volume of blood remaining in each ventricle at the end of diastole
130ml

EJECTION FRACTION
Ejection Fraction refers to the fraction of EDV that is ejected out by each
ventricle per beat.
Normal ejection fraction is 60% to 65%.
EF = SV/EDV x 100
 VARIATIONS IN CARDIAC OUTPUT
 PHYSIOLOGICAL VARIATIONS:
• AGE: Cardiac output is more in adults than in children because blood volume is more.
• Gender: Cardiac output is more in male than females.
• Pregnancy: During the later months of pregnancy, cardiac output is increases by 40%.

• Exercise: Cardiac output increases during exercise Max , because when we are doing
exercise the sympathetic activity is increased, it will increase the cardiac output and
heart rate.

• Emotional conditions: Anxiety, and excitement increases the cardiac output about 50%
to 100% through the release of catecholamines, which increase the heart rate and
force of contraction.
 Cond…

Altitude: Cardiac output increases at high altitude, because of increase of secretion of

adrenaline. Adrenaline secretion is stimulated by hypoxia( lack of oxygen).

Decreased Cardiac Output,

• Sleep – cardiac output is slightly decreased or it is unaltered during sleep.

• Posture – while changing from supine position to upright position , the cardiac
output is decreases.
Cond..
 PATHOLOGICAL VARIATIONS:
Increased Cardiac Output,
• Thyrotoxicosis
• Cushing’s syndrome
• Anemia
Decreased Cardiac Output,
• Atrial fibrillation
• Congestive cardiac failure
• Complete heart block
• Myocardial infarction
• Hemorrahage
 REGULATION OF CARDIAC OUTPUT
Cardiac output is maintained by four factors,,
1. venous return
2. Force of contraction
3. heart rate
4. peripheral resistance
VENOUS RETURN

Amount of blood that returns to RT.atrium from systemic venous circulation

↑ venous return
↓
↑ EDV
↓
↑ Stretching of myocardium
↓
↑ Force of contraction
↓
↑ Stroke volume
↓
↑ Cardiac output
i. The Respiratory Pump
 FORCE OF CONTRACTION
• FRANK STARLING LAW
• Force of contraction of cardiac muscle is directly proportional to the initial length
of muscle fibre within physiological limit
• PRELOAD
Preload forms the end diastolic volume (EDV)
Load acts on the muscle before it starts to contract
• AFTERLOAD
Force against which ventricular muscle fibres shorten
Resistance offered against ejection of blood from ventricles
Peripheral resistance is the afterload
CARDIAC OUTPUT IS INVERSELY PROPORTIONAL TO AFTERLOAD
 Regulation of heart rate

Sympathetic nervous system

- sympathetic nerves release norepinephrine, act on ß-receptors on sinoatrial
node , it increases slope of the pacemaker potential.
- Increases heart rate.

Parasympathetic nervous system

– vagus nerve releases Acetylcholine
– acts on muscarinic receptors on sinoatrial node
– hyperpolarises cells and decreases slope of pacemaker potential
– decreases heart rate
 Determination of Cardiac Output
• Direct method
• Recorded in animals by Electromagnetic flowmeter
• Indirect method
• Fick principle
• Indicator / Dye Dilution method
• Thermodilution
• Inhalation of inert gases – nitrous oxide, acetylene
• Ballistocardiography
• Doppler technique Echocardiography
 Determination of CO by using Fick principle
The amount of substance taken by an organ in unit time is equal to the difference in
the arteriovenous concentration of the substance times the blood flow.
Q = (A-V) F

F = Q/ (A-V)
 CARDIAC OUTPUT AND THE FICK
PRINCIPLE
BODY O2 CONSUMPTION

Lungs

250mlO2/min
PULMONARY PULMONARY
ARTERY VEIN

PaO2 PvO2

0.15mlO2/ml blood 0.20mlO2/ml blood

Pulmonary capillaries

O2 CONSUMPTION (ml/min)
CARDIAC OUTPUT=
PvO2 - PaO2
Cond..

O 2 consumption(mL/ min)
Cardiac Output 
[O 2 ]a  [O 2 ]v
250 mL/ min

0.20mL / L  0.15mL/L
250 mL/ min

0.05mL/L
 5 L/ min
• DISADVANTAGES
• Invasive,
• Infection
• Hemorrhage
• Ventricular fibrillation

• Cardiac output = CO2 output / PACO2- PVCO2

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