Cardiovascular system

(CVS)

Cardiac output

Dr. Ramadan Saad

 Cardiac Output
(COP)
Beat = stroke volume (SV)
= EDV – ESV
= 70 ml

Volume of blood ejected Minute = Cardiac output (COP)

from one ventricle = SV x HR
= 5 liters / min

Minute / square meter of body

surface area
= Cardiac index
= 3.2 liter / min / m2
Ejection Fraction:
Definition: It is the ratio of SV compared to EDV.
SV 70
= X 100 = X 100
EDV 135

Value: Normally it is about 50 – 60 %.

Importance:
It is used as indicator for myocardial
contractility.
Factors affecting cardiac output
1- Stroke volume 2- Heart rate
(SV) (HR)

3- Venous return (VR)

Preload
 Effect of mild or moderate increase of heart rate
(Associated with increase in the venous return)
Ex. Sympathetic stimulation
2- Effect of mild or moderate increase in heart
rate
(with constant venous return)
1- Stroke volume (SV)
3- Effect of increased venous return
(Preload)
 Cardiac Output

function of

Heart Rate Stroke Volume

determined by determined by

Rate of depolarization Force of contraction in

of autorhythmic cells ventricular myocardium

influenced by
slowed by made faster by

parasympathetic
sympathetic input contractility length-tension
input
relationship of
epinephrine from muscle fibers
adrenal medulla
which varies with
influence
venous return

aided
by

skeletal muscle respiratory

pump pump
Mediators of Cardiac Output

CARD IA C OU TPUT

H eart Rate Stroke V olu m e

Preload A fterload Contractility

Preload and Afterload
THE END
 Regulation of Cardiac output

Intrinsic regulation
Extrinsic regulation
(Auto regulation)
* It depends on *It is the ability of the heart to
- Nervous supply of the change its stroke volume
heart. - independent of nervous chemical
Hormones or chemical or hormonal factors.
* It adjust * It include
both stroke volume
and heart
rate. Heterometric Homeometic
autoregulation autoregulation
 Intrinsic autoregulation
1-Heterometric autoregulation:
* It is rapid mechanism and has a short duration (transient).
* It is initiated by increase venous return.
ex. - Change of body posture from standing to recumbent position.
- The start of muscular exercise.

* It is preload phenomenon depending on Starling low

Increase venous return increase EDV increase initial
muscle fiber length (within limit) increase force of
ventricular contraction Increase stroke volume & cardiac
output.

*EDV is increased.
*ESV increased slightly or remains constant.
*It is followed by homeometic autoregulation.
2-Homeometic autoregulation:
It follows the heterometric regulation.

It can occur for long time.

It is an after load phenomenon.

It is initiated by the increase in aortic pressure.

The increase in myocardial contraction increase

SV by the decrease in ESV.

 EDV returns to the normal value (not changed).

 Heterometric Homeometeric
Sequence Occurs at first (followed Following the
by homeometic heterometric regulation.
regulation).
 Heterometric Homeometeric
Sequence Occurs at first (followed Following the
by homeometic heterometric regulation.
regulation).

Onset Slow
Rapid (after few min)
(Immediate after increase
in VR)
 Heterometric Homeometeric
Sequence Occurs at first (followed Following the
by homeometic heterometric regulation.
regulation).

Onset Slow
Rapid (after few min)
(Immediate after increase
in VR)

Duration Long
Short (Maintain the elevated
(few minutes) stroke volume for long
time).
 Heterometric Homeometeric
Sequence Occurs at first (followed Following the
by homeometic heterometric regulation.
regulation).

Onset Slow
Rapid (after few min)
(Immediate after increase
in VR)

Duration Long
Short (Maintain the elevated
(few minutes) stroke volume for long
time).

EDV No change
Increase
 Heterometric Homeometeric
ESV Constant Decrease
(or slightly increased)
 Heterometric Homeometeric
ESV Constant Decrease
(or slightly increased)

SV Increase Increase

 Heterometric Homeometeric
ESV Constant Decrease
(or slightly increased)

SV Increase Increase

Stretch of Present Absent

ventricular
muscle
fibers.
 Heterometric Homeometeric
ESV Constant Decrease
(or slightly increased)

SV Increase Increase

Stretch of Present Absent

ventricular
muscle
fibers.

Mechanism Starling low Increase of the aortic

pressure
 Heterometric Homeometeric
ESV Constant Decrease
(or slightly increased)

SV Increase Increase

Stretch of Present Absent

ventricular
muscle
fibers.

Mechanism Starling low Increase of the aortic

pressure
Phenomenon
Pre load After load.