CARDIAC

OUTPUT
II
:BY
Makkawi .A.A. Osman
B.Sc, M.Sc
Department of physiology
Session No – (6)
Control of COP
COP= HR X SV
So its controlled by controlling the heart
rate & the stroke volume
Control of the SV:-
SV is the volume of blood ejected by each
ventricle each beat.
It equals the difference between the EDV
& the ESV, that is about 130 – 50 = 80 ml
(range 70 – 90 ml /beat)
Cardiac out put
Stroke Volume

Figure 20–19
A. Neural control :-
Sympathetic stimulation exert a +ve
inotropic effect & ↑ the SV by following
Mechanism :
Norepinephrine & epinephrine by acting
on the cardiac beta 1 adrenergic receptors ↑
the intracellular c AMP in the cardiac muscle
fibers which lead to activation of the Ca2+
channels & more Ca2+ influx from the ECF
this Ca2+ triggers release of Ca2+ from the
sarcoplasmic reticulum , ↑ the contractility &
SV
 Norepinephrine calcium

AC
CAMP
calcium
ATP calcium

Sarcoplasmic
Reticulum
Parasympathetic stimulation
has no direct inotropic effect
because it does not supply the
ventricle
So that does not effect the SV
Innervation of the Heart

Figure 20.21
 B. Starling’s law of the heart (Intrinsic):-
This is the regulation of the SV by changing the
initial length of the muscle fibers
Law states that : with in physiological limit , the
force of myocardial contraction is directly
proportional to the initial length of the cardiac
muscle fibers ( i.e. to the preload or EDV in the
intact heart )
The ↑ filling of the ventricle leads to its
expansion , thus the EDV & length of the muscle
fibers ↑ & according to the Starling’s law
 the ↑ in the force of contraction
leading to an ↑ of the SV.
This regulatory mechanism
adjusting the COP according to
the change in the VR.
Frank - Staring low
C. Hormonal regulation :-
SV is increased by catecholamine &
thyroid hormones
Thyroid hormones act indirectly by
increasing the number & affinity of the B1
receptors in the heart to the catecholamine
because thyroid hormone is anabolic
hormone
Glucagon exert +ve inotropic effect & ↑ SV
because it ↑ the formation of c AMP which
allow more Ca2+ influx
D. others factors :-
SV is increased by exercise
E. Drugs :-
SV is increased by Digitalis.
Mechanism: it inhibits the Na+ - K+
ATPase in the myocardium resulting in
accumulation of Na+ in the ICF , this
activate a Na+ - Ca2+ antiport which takes
Na+ to the out side & Ca2+ to the inside ,
which ↑ the intracellular Ca2+ content that
↑ the contractility & SV
Caffeine :- +ve
inotropic effect by
inhibit the break
down of cAMP
The venous return
 VENOUS RETURN (VR)
Is the volume of blood that return back
to the heart per unit time.
The normal VR during rest is about 5.5
L/min
It ↑ during exercise up to about 25 – 35
L/min.
 FACTORS AFFECTING THE VR
1. Pressure gradient :-
 This the is most important
factor that affects the VR .
 it acts through all conditions.
2. RESPIRATORY PUMP :-
Inspiration ↑ the VR by ↑ the negativity of
the intra thoracic pressure which ↑ the
pressure gradient along with the blood
flow to the heart
Expiration ↓ the VR by ↓ the negativity of
the intra thoracic pressure
In pneumothorax the VR is markedly ↓
because the intra thoracic pressure
become above atmospheric pressure or +
ve
Respiratory Pump
3. MUSCLE PUMP :-
Contraction of the skeletal muscle
squeeze the deep vein with in the
muscle and blood move upward
toward the heart due to presence of
valves in these veins which directed
blood forward
Varicose vein
which is due to congenital abnormality of
the Venous valve.
4. GRAVITY :-
Standing ↓ the VR because the blood
pools in the lower limbs by the effect of
gravity
So that VR is ↑ in supine position

5. Blood volume :-
Bleeding ↓ the VR by ↓ the total blood
volume , while ↑ the total blood volume
increasing the VR
6. VENODILATION &
VENOCONSTRICTION:-
Venodilation ↓ the VR because it ↑ the
diameter of these capacitance vessels to
store the blood
Venoconstriction by sympathetic
stimulation (e.g. during exercise ) ↑ the
VR.
7. STATE OF HEART VALVE:-
Stenosis regurgitation of any of the heart
valves ↓ VR & result in heart failure
8. INTRAPERICARDIAL PRESSURE :-
It ↑ e.g. a result of fluid or blood
accumulation in the pericardial sac
which decreasing flow of blood
through the veins that cross this sac
to drain blood into the atria &
decreasing the VR
9- Spleen contraction:-
increase VR by effect of symp.
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‫اكتشاف صفات القلب من القرآن؟؟!‬
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‫معظم الذين يزرعون قلبا ً صناعيا ً يشعرون بأن قلبهم الجديد قد تحجَّ ر‬
‫‪،‬ويحسون بقسوة غريبة في صدورهم‪ ،‬وفقدوا اإليمان والمشاعر والحب‬
‫‪:‬وهذا ما أشار إليه القرآن في خطاب هللا تعالى لليهود‬
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‫ا__ل ِح َج َ‬
‫ف___قد ح_ ّدد ل__نا ا__لقرآ_نص__فتينمنص__فاتا__لقلبوهما ا__لقسوة وا__للين‪ ،‬وهذا ما ل__م_‬
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