SEMINAR

PRESENTATION ON:

METHODS OF MEASUREMENT OF CARDIAC OUTPUT

PHS412 (GROUP 10)

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 OBJECTIVES
At the end of this seminar, students should be
able to:
• Define cardiac output
• Understand the methods of measurements of
cardiac output
• Know the parameters of cardiac output

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 INTRODUCTION
 
• The human heart is responsible for pumping blood
to different parts of the body, delivering oxygen
and nutrients and removing waste products.
• Cardiac output (CO) is the volume of blood
pumped by the heart per minute and is a crucial
parameter in evaluating cardiac functions.
• Measuring CO is important in various settings,
such as diagnosis and in the management of heart
failure, shock, and during surgeries.
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 DETERMINANTS OF CO
• A normal value of cardiac output at rest is about 5
L/min. A sample formula holds for cardiac output;
CO = SV x HR
• CO-cardiac output, SV-stroke volume, HR-heart rate.
• CO = HR X SV
= 72 beats/min x 70ml/beat
=5040ml/min
5L/min

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 CHANGES OF CARDIAC OUTPUT
• Cardiac output can increase five (5) times its
resting value if needed. These changes are
mostly due to the changes in the heart
frequency (it can go up to 180-220
strokes/min), but also due to increase of
stroke volume.

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PARAMETERS OF CARDIAC OUTPUT
• Cardiac output depends substantially on the
body size. However, it is proportional to the
body surface area rather than the total body
mass.
• In order to do that we define cardiac
index(CI)
CI = CO/BSA
Where BSA is body surface area

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FACTORS AFFECTING CARDIAC OUTPUT

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FACTORS AFFECTING CARDIAC OUTPUT

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 MEASUREMENT OF CARDIAC OUTPUT

• Several methods are available for measuring

CO, and they can be broadly classified into
Invasive and non-invasive techniques.
• Invasive methods require the insertion of a
catheter into the heart or major blood vessels.
• Non-invasive method do not require any
catheterization or invasive procedure.

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 INVASIVE METHODS
• Thermodilution technique: In this method CO is measured by
use of Swan Ganz catheter. It is the modified indicator dilution
method and a popular method to measure cardiac output.
• In this method, a known volume of cold sterile solution is
injected into the right atrium via inferior vena cava by using a
catheter.
• Cardiac output is measured by determining the resultant
change in the blood temperature in pulmonary artery. For this
purpose, two thermistors (temperature transducers) are used.
One of them is placed in the inferior vena cava and the second
one is placed in pulmonary artery. A pulmonary artery catheter
is used to place the thermistors in their positions.
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 INVASIVE METHODS Cont’d
• Fick principle: Fick principle is used to
measure the cardiac output by
determining the amount of substance
taken up by an organ or given out in a
unit of time is the product of amount
of blood flowing through the organ in
the body in a given period of time and
the arteriovenous difference of the
substance across the organ. 11
 INVASIVE METHOD CONT’D
• Pulmonary artery catheterization: This
method involves inserting a catheter through
a central vein into the pulmonary artery to
measure the pressure and temperature
changes across the pulmonary circulation.
These changes can be used to calculate CO.

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 NON-INVASIVE METHODS
• Echocardiography: This method uses ultrasound
waves to visualize the heart and measure the blood
flow velocities. CO can be calculated from the
velocity measurements and the cross-sectional area
of the blood vessel.
• Doppler ultrasound: This method uses ultrasound
waves to measure the blood flow velocities in the
heart and blood vessels. CO can be calculated from
the velocity measurements and the cross-sectional
area of the blood vessel
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 NON-INVASIVE METHODS Cont’d
• Cardiac magnetic resonance imaging (MRI): This method
uses magnetic fields and radio waves to produce images of
the heart and blood vessels. CO can be calculated from the
velocity measurements and the cross-sectional area of the
blood vessel.

• Impedance cardiography(measuring electrical resistance of

the chest): This method measures the changes in electrical
impedance across the thorax during the cardiac cycle. These
changes can be used to calculate stroke volume, and hence,
CO. The method is non-expensive and non-invasive but not
accurate.
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 NON-INVASIVE METHODS Cont’d
• Computed tomography (CT): This method uses X-rays
to produce images of the heart and blood vessels. CO
can be calculated from the velocity measurements
and the cross-sectional area of the blood vessel.
• Magnetic resonance: Resonance properties of protons
in the nucleus do change with respect to velocity.
Thus, magnetic resonance can be used as an accurate
way to measure the flow in aorta (cardiac output). The
method is expensive, it is only used in research.

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 COMPARISON OF BOTH METHODS
• Invasive methods are considered the gold standard for
measuring CO, as they are more accurate and precise than non-
invasive methods. However, invasive methods are associated
with risks such as infection, bleeding, and arrhythmias.
• Non-invasive methods are safer and more convenient, but they
are less accurate and are affected by several factors such as
body habits, pulmonary disease, and poor image quality.
• The choice of method for measuring CO depends on the clinical
situation, the patient's condition, and the resources available.
In emergency situations, invasive methods may be preferred,
while non-invasive methods may be preferred in stable
patients.

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 CONCLUSION
• In conclusion, measuring CO is essential for assessing
cardiac function and managing patients with
cardiovascular diseases. Different methods are
available for measuring CO, and they have different
advantages and disadvantages. Clinicians should
choose the appropriate method based on the clinical
situation, patient's condition, and available
resources. Further research is needed to improve the
accuracy and precision of non-invasive methods and
to identify the optimal method for measuring CO in
different clinical settings.
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 REFERENCES
• Guyton AC, Jones CE, Coleman TG, Normal cardiac output and
its variations. Chap1. In circulatory physiology: Cardiac output
and its regulation. Pp. 3-20. WB Saunders, London,1973.
• Saltin B. Physiological effects of physical conditioning. Med Sci
Sports. 1968; 1: pp.50-57.
• Young DB, Murray RH, Bengis RG, Markov AK, Experimental
angiotensin 11 hypertension. Am J Physiol. 1980; 239(3): pp.
H391-98.
• Guyton AC, Lindsey AW, Kaufmann BN, Abernathy JB. Effect of
blood transfusion and hemorrhage on cardiac output and on
the venous return curve. Am J Physiol. 1958;194(2): pp.268-67.

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 CONT’D REFERENCES
• Guyton AC, Jones CE, Coleman TG. Circulatory
physiology: Cardiac Output and its Regulation. P.161
WB saunders, London.1973
• Levy MN, Zieske H. Autonomic control of cardiac
pacemaker activity and atrioventricular transmission. J
Appl Physiol. 1969;27: pp.465-70
• Guyton AC, Abernathy B, Langston JB, Kaufmann BN,
Fairchild HM, Relative importance of venous and
arterial resistance in controlling venous return and
cardiac output. Am J Physiol.1959; 196(5): pp. 1008-14.

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THANKS FOR LISTENING

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