CARDIAC OUTPUT

CARDIAC OUTPUT
• Cardiac output is the amount of blood ejected from each ventricle in each minute\
• Factors depend : stroke volume and heart rate
• If there any variations in this factors will affect the cardiac output
• Normal value : 5-6 litres

Stroke volume
• It is the amount of blood pumped from each ventricle in a beat
• Normal value : 60-80 ml
Heart rate
• Heart rate is the number of heartbeats per minute.
• It is the major determinant of cardiac output
• Normal value : 72 beats/min
 Variations in cardiac output
1. Physiological variations
2. Pathological variations

Physiological variations

a) Age : less in children due to less blood volume

b) Gender : decreased in females

c) Diurnal variations : less in morning and increased towards afternoon

d) Emotions : Adr release will increase the cardiac output, heart rate and force of

contraction of heart

e) Exercise: increase in body movement will increase the cardiac output

Pathological variations
• Cardiac output increase during fever, anaemia, hyperthyroidism

Fever
• Cardiac output increases
• Two reasons for increase in CO during fever

1. During fever body temperature increases. The increase in temperature leads to

rise in heart rate thereby increase in cardiac output

2. Due to some infections there will be a chance or fever, to destroy the bacterias

on infected site more WBC are needed. So that there is need for increase in

blood flow. During this period heart rate increases and automatically cardiac

output increases
Anaemia
• The decrease in RBC count or decrease in Hb count is called anaemia
• During anemic condition cardiac output increased.

Anaemia a condition developed called anemic hypoxia.

peripheral chemoreceptors get activated.

At that time information passes to the medulla and get stimulated.

leads to increase in heart rate for reaching the blood to the lungs to increase the

oxygen demand

finally cardiac output increases

Hyperthyroidism
• Condition in which Increase in the thyroid level hormone is called hyperthyroidism

• Thyroid hormone is responsible for the regulation of heart rate , CV activities,

respiratory activities .

• Increase in thyroid hormone level leads to increase in cardiac output

Pathological variations
• Cardiac output decreased during hypothyroidism, heart failure, shock,
hemorrhage
Factors maintaining cardiac output
Venous Return

It is the amount od blood returned to the heart from different parts of the body is

called venous return

• If amount of blood t the heart increases, stroke volume increases and cardiac

output will also increased

Venous return depends on 5 factors ;

1. Respiratory pump

2. Muscle pump

3. Gravity

4. Venous pressure

5. Sympathetic tone
Muscle pump

Muscular activities that helps return the blood back to the heart

Blood flow from the down part of the leg so the Valves opens in upward direction so that blood
moves to next part
• Skeletal muscles movement occurs during exercise or any other body movements leads into
the increase in circulation
• Valves in veins opens in upward direction
• From lower parts of the body blood moves or the blood reaches to the muscle parts.
• When muscles relaxed : the space inside the veins also relaxed.
• When muscles contracted: veins inside the muscles get compressed or get squeezed, the
valve in veins opens into upward direction. The blood inside the vein squirting back to heart
Respiratory pump
• Respiration is the process of taking in fresh air and exhalation of the used air.
• Respiratory activity that helps return of the blood back to the heart during
inspiration
• It is also called abdomino - respiratory pump
• During inspiration the blood will reaches to the heart

The blood to inferior venacava in thoracic area due to the movement of diaphragm
( during inspiration, diaphragm move and it will compressed in area of abdominal cavity )

The blood vessels in inferior venacava in abdomen area get compressed

The region of inferior venacava in abdomen part compresses

The blood from this region reaches to the dilated area of inferior venacava in thoracic area

Free movement of blood

heart
Venous pressure

• Increases venous return by propelling the blood back to the heart

• Increases in the pressure inside the veins leads to increase in venous return

Sympathetic Tone

• Causes venoconstriction

• Increase in the sympathetic activity (release of Adrenaline) causes the constriction

of the blood vessels and heart, Pushes blood to the heart and so venous return

increases
Gravity
• Reduces venous return in standing posture : cause polling of the blood in the
legs called venous pooling so the amount of blood returning the heart
decreases.
Force of contraction of Heart
It depends upon
a) Diastolic period
b) Ventricular filling

• According to the frank-starling law, the force of contraction of heart is directly

proportional to the initial length of the muscle fibre before the onset of

contraction

• The force of contraction also depends upon the preload and afterload

• Preload is the stretching of the muscle fibres at the end of the diastole just before

contraction
• Afterload is the force against which the ventricles must contract and eject the
blood
Peripheral resistance

Resistance : obstruction to flow

Peripheral resistance : resistance offered to the blood flow at the peripheral blood

vessels

• Peripheral resistance leads to decrease in the venous return thereby decrease in

the stroke volume i.e, stroke volume is inversely proportional to peripheral

resistance

• Peripheral resistance is offered at arterioles. So they are called resistance vessels

 Regulation of Heart Rate
• Heart rate is the number of heartbeats per minute.

• It is the major determinant of cardiac output

• Normal value : 72 beats/min [ it ranges from 65-85 beats/min]

• Mainly it arises from SA node

• Cardiac muscles are self excitable and autorhythmic and the autorhythmicity done

by SA node ( they produce heartbeat at regular intervals of time)

• Increase in heart rate : tachycardia : above 85 beats/min

• Decrease in heart rate : bradycardia : below 65 beats/min

• Heart rate is regulated by nervous mechanism

Normally the heart has complete freedom to produce the heart beat rhythmically

own its own. If this limit exceeds i.e, during tachycardia and bradycardia SA node and

AV node is unable to maintain the heart rate to normal condition. The brain is then

involved in this condition.

3 components

• Vasomotor center (medullary CV center)

• Motor nerve to the heart

• Sensory nerves from the heart

Vasomotor center
• It is seen in the medulla so this is also called medullary vasomotor center
Vasoconstrictor area

• Constrict heart and blood vessels

• This area will increase heart rate and blood pressure (i.e, increases the cardiac

activities)

• Vasoconstrictor area also called cardioaccelarator area / pressor area

Vasodilator area

• dilate heart and blood vessels

• This area will decrease heart rate and blood pressure (i.e, decrease the cardiac

activities)

• Vasodilator area also called cardioinhbitory area / depressor area

Sensory area

This areas receives sensations from the heart and controls other 2 areas

Eg :

If heart rate is above 85 beats/min

This information passes to sensory area

Stimulate vasodilator area

Dilate heart and blood vessels

Decrease heart rate

Autonomic nerves

Motor nerves to the heart : autonomic nerves

Parasympathetic nerve (vagus nerve) – connected to the vasodilator area

Vagus nerve

• It is the 10th cranial nerve

• Most important nerve in the body

• Supplies to the heart

• It is connected to the vasodilator area so that controls the heart rate and blood

pressure

sympathetic nerve– connected to the vasoconstrictor area : increase heart rate and

BP
Eg: emotional time, tension, fear

Sympathetic nerve gets activated there by release of neurotransmitter (Adrenaline)

leads to increase in heart beat

• The response brings from vasomotor center is called motor nerves. They are mainly

autonomic nerves.
• The function of sympathetic and parasympathetic nerves is same but their action

is different

Eg : heart

Function : Sympathetic and parasympathetic nerves supplies to the heart. They

control the heart rate and blood pressure to maintain in normal range

Action :

Parasympathetic nerves : decrease the cardiac activities

Sympathetic nerves : increases the cardiac activities

Other body organs

Action :

Parasympathetic nerves : increases the body functions

Sympathetic nerves : decreases the body functions

• Parasympathetic nerve supplies to main areas such as SA node and AV node

• In case of Sympathetic nerve, there is group called sympathetic ganglion from

there it arises as singe nerve. When they reaches to brain it get splitted into 4 or 5

branches. Each branch supplies to each areas of conductive system ( SA node, AV

node, bundle of His, purkinji fibres). This creates a huge increase in the heart rate.

• So in-order to control this condition, this action is coordinated by parasympathetic

nerve through a set of impulses called vagal tone.

Vagal tone

Continuous stream of inhibitory impulses arising from the vasodilatory area of the

medulla.

• This impulses arises from vasodilator area passes through parasympathetic nerve

(vagus nerve) reaches to heart.

• So the heart beats according to the impulses to the heart

• Heart rate is inversely proportional to vagal tone

• Vagal tone increases---- increase in inhibitory impulses--- less heart rate

• Heart rate is regulated by the vasomotor center by altering the vagal tone
Sensory nerve

• Nerve : superior cervical sympathetic nerve

• This receives information from the cardiac tissue and deliver to the sensory area

of the vasomotor center.

 Factors affecting cardiovascular reflexes
1. Impulses from the higher brain centers-decreases the vagal tone thereby
increase heart rate
• Eg : emotions
hypothalamus----activated—decrease in vagal tone---heart rate increases

2. Impulses from respiratory centers-deep inspiration increases heart rate and deep
expiration decreases heart rate
• Depend upon the information reaches to the respiratory centers, heart rate will
increase or decrease
3. Impulses from baroreceptors – Marey’s reflex
4. Impulses from chemoreceptors
5. Impulses from right atrium
 Baroreceptor reflex

Receptor

• It is an agent on which a stimulus acts

• They are specific

Baroreceptor reflex

Reflex that occur upon the stimulation of baroreceptors that respond to changes in

BP.
 Increase in BP

Stimulated baroreceptors in carotid sinus and aortic arch

Baroreceptors sends stimulatory impulses to vasodilatory area

Increase vagal tone

Decrease heart rate, also BP

 Chemoreceptor reflex

Chemoreceptor reflex

Reflex that occur upon the stimulation of chemoreceptors that respond to changes in

oxygen and carbon dioxide level in the blood.

Eg : taste buds, sensory hairs in nose

• Variations in oxygen and carbon dioxide will activated the chemoreceptors

• These are also seen on aortic arch and carotid sinus

 Hypoxia / hypercapnea

Stimulate peripheral chemoreceptors in carotid sinus and aortic arch

Inhibitory impulses to vasodilatory area

decrease vagal tone

increase heart rate

 Bainbridge reflex
• Also called right atrial reflex
• Acceleration of heart rate by increase right atrial pressure
• Due to stimulation of atrial receptors

Increase venous return to RA

RA get stretched

Stimulate stretch receptors

Excess blood fill in the heart and ejection of excess blood

Heart rate increases

Stretch receptors send inhibitory impulses to vasodilatory area

Decrease vagal tone