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Cardiac Output: Prof. K. Sivapalan

Cardiac output is the volume of blood pumped by each ventricle in one minute. It is calculated by multiplying stroke volume by heart rate. Stroke volume is the volume of blood pumped in one beat and is determined by the difference between end diastolic and systolic volumes. Cardiac output can be measured using dilution methods that inject dye or cold water and monitor its concentration in arterial blood over time. Factors that affect cardiac output include venous return, heart rate, contractility, and cardiac metabolism which depends on heart rate, tension, and the contractile state of the myocardium.

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58 views

Cardiac Output: Prof. K. Sivapalan

Cardiac output is the volume of blood pumped by each ventricle in one minute. It is calculated by multiplying stroke volume by heart rate. Stroke volume is the volume of blood pumped in one beat and is determined by the difference between end diastolic and systolic volumes. Cardiac output can be measured using dilution methods that inject dye or cold water and monitor its concentration in arterial blood over time. Factors that affect cardiac output include venous return, heart rate, contractility, and cardiac metabolism which depends on heart rate, tension, and the contractile state of the myocardium.

Uploaded by

jikook
Copyright
© © All Rights Reserved
Available Formats
Download as PPSX, PDF, TXT or read online on Scribd
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Cardiac Output

Prof. K. Sivapalan

2013 Cardiac output 1


Cardiac output.
• Stroke volume:- volume of blood pumped in one
beat.
• SV = End diastolic volume – End systolic
volume.
• Ejection fraction
= stroke volume / end diastolic volume x 100 = 65 %.
• Heart rate :- number of heart beats per minute.
• Cardiac output is the volume of blood pumped
by each ventricle in one minute.
• CO is equal for both ventricles but stroke volume
could vary between ventricles.

2013 Cardiac output 2


Measurement of cardiac output.
• Cut aorta and collect blood
– not accurate, not possible.
• Dilution method.
– Indocyanine green-dye
– Cold water.
• Inject dye or cold water into vein and monitor the concentration in
arterial blood. The dye enters right heart, pulmonary circulation, left
heart and into peripheral circulation.
– The concentration increases rapidly and declines because of washing
out from cardiac chambers, and starts rising again as it returns for the
second time.
– Extrapolate the decline to calculate average concentration [assuming
all blood is collected]
• Flow in measured time = amount injected divided by average
concentration [or temperature].
• Fick principle:
– Output = O2 consumed [mL/min] divided by difference between arterial
and venous blood [mL/min].
• Echocardiogram

2013 Cardiac output 3


Cardiac index.
• Cardiac index = cardiac output per minute
per square meter body surface.
• 3.2 L / min / M2.
• Useful to compare individuals.

2013 Cardiac output 4


Factors affecting C.O.
Cardiac output depends on,
 Venous return [Frank Starling law].
Benefit for transplant patients.
 Heart rate [ventricular filling].
 Catecholamines [force of contraction].
Within physiological range,
cardiac out put is not affected by
peripheral resistance.
2013 Cardiac output 5
Cardiac metabolism.
• Oxygen consumption [metabolism] of
– myocardium (stopped)- 2 ml / 100 g / min.
– skeletal muscle 0.2 ml / 100 g / min.
– Beating heart at rest- 9 ml / 100 g / min.
• Energy requirement depends on,
– Heart rate
– Intra myocardial tension
– Contractile state of myocardium
• Intra myocardial tension [wall] generates intra
cardiac pressure according to the law of
Laplace.

2013 Cardiac output 6


Intra mural pressure and wall
tension.

2013 Cardiac output 7


Contractile state of myocardium.
• Sympathetic and parasympathetic
impulses.
• Circulating catecholamines..
• Hypoxia, hypercapnoea, acidosis.
• Loss of myocardium.
• Drugs- depressants and stimulants.
• Intrinsic depression.

2013 Cardiac output 8


Cardiac work.
• In heart, P = TW/r
– [P- pressure, T-tension, W- thickness, r- radius.]
• When pressure is same and radius increased, tension also
increased. – disadvantage in cardiac dilatation.
• But increase in thickness is beneficial.
• Mechanical work per beat:
=QR + MV2 / 2G [G = 9.8 g.m.]
(Q-Stroke volume, R- Mean arterial pressure, M- mass of blood
pumped, V- mean velocity in aorta.
• R in systemic circulation is 7 times more than in pulmonary
circulation.
• Increase in pressure work [after load] causes higher increase in
oxygen consumption than with volume work [preload].

2013 Cardiac output 9

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