CARDIAC OUTPUT
DEFINITION
The amount of blood ejected by each ventricle in the
circulation per minute is called Cardiac Output
Normal Value: 5-6 Litters/minute
The Cardiac output Expressed in Three Terms
STROKE VOLUME
It is the amount of Blood pumped out by each ventricle during each beat
Normal Volume – 70ml
MINUTE VOLUME
It is the amount of blood pumped out by each ventricle in one minute. It is the
product of stroke volume and heart rate
Minute Volume - Stroke Volume x Heart rate
Normal Volume – 5liters/ventricle/Minute
• CARDIAC INDEX
• The Cardiac Output per square meter of the body surface area per minute
• The Cardiac Output is directly proportional to the metabolic rate ie surface area
& body weight
• CARDIAC RESERVE
• The maximum amount of blood that can be pumped out by heart above normal
value
PHYSIOLOGICAL
VARIATIONS
Cardiac Output Increases in:
Emotional Conditions like Anxiety, Excitement, stress
Muscular Exercise – rises up to 25 - 35 lit /min
After meal – After 1hr of meal there is 30% - 40% rise of cardiac output and
declines after 3hrs
Pregnancy
High environment temperature
High Po2 in the inspired air
Low Pc02 in the inspired air
Cardiac output Decrease in:
Sitting or Standing from lying posture
Depression
It is less in Elderly people due to decrease in Heart rate and Stroke Volume
It is also less in Female
PATHOLOGICAL VARIATIONS
Cardiac Output increases during Hypertension
Cardiac Output decreases during Haemorrhage, Myocardial Infarction, and
Acidosis etc
DISTRIBUTION OF CARDIAC
OUTPUT
Liver - 1500 ml - 30%
Kidneys - 1300 ml - 26%
Skeletal Muscles - 900 ml - 18%
Brain - 800 ml - 16%
Skin, Bones & GIT - 300 ml - 6%
Heart - 200 ml - 4%
TOTAL - 5000 ml - 100%
FACTORS AFFECTING CARDIAC
OUTPUT
• Venous Return
• Force of Contraction
• Heart Rate
• Peripheral Resistance
• Venous Return
It is the amount of blood which is return to the Heart from different
parts of the body is called Venous Return
It is directly proportional to Cardiac Output. Any factor that increase
or decrease the venous return will change the Cardiac Output
Venous return depends upon
Muscle Pump [Works against Gravity]
During Muscular Exercise Veins are compressed by muscles
Due to the presence of valves in the Veins, during compression the blood is
moved towards Heart. The muscular activity increases & venous return is more
When Skeletal Muscles contract, the Proximal Valve of the vein is opened and the
Digital valve is closed to prevent the back flow of blood i.e. Muscle Pump
Respiratory Pump
During Inspiration the intra thoracic pressure falls and intra abdominal pressure
increases. Hence at each inspiration venous blood sucked up by thorax and
pumped out by abdomen. So, during inspiration venous return will be more
• Gravity
• Reduces the venous return in prolonged standing because of venous pooling into
the lower limb
• Venous Pressure/ Capillary Pressure
• Pressure in the capillaries, venules is more i.e. Positive Pressure, where as in the
great veins pressure is low i.e. Negative Pressure. Because of pressure gradient in
venous tree, the venous return is more
• Force of Contraction
Cardiac Output is directly proportional to the force of contraction. It depends upon
the diastolic pressure and ventricular filling
According to Frank Starling’s law, a force of contraction of the heart is directly
proportional to the length of the heart is directly proportional to the initial length
of the Cardiac muscle before the onset of contraction
Pre Load
During diastolic period in the ventricular filling the length of the muscle fiber
increased and it also increases the End diastolic pressure. It is called Preload
After Load
During ventricular systole semi lunar valves open and blood ejects into Aorta and
pulmonary trunk is called After Load
• HEART RATE
It is directly proportional to the Cardiac Output. So moderate change in Heart
rate will not alter the Cardiac Output
• If there is marked increase in heart rate the Cardiac output increases and the Heart
rate becomes too slow, then the Cardiac Output decreases significantly
• PERIPHERAL RESISTANCE
It is the resistance or load against which the Heart has to pump the blood. So the
Cardiac Output is inversely proportional to Peripheral Resistance
