Cardiac Output

Graphics are used with permission of: Pearson Education Inc., publishing as Benjamin Cummings (http: www.aw!bc.com"

Page 1. Introduction # Cardiac output is the amount of blood pumped out b$ each %entricle in one minute. # Cardiac output can increase mar&edl$ to meet the demands placed on our bod$, whether dashing to catch a bus or riding a mountain bi&e, Page 2. Goals # 'o recogni(e that cardiac output %aries directl$ with heart rate and stro&e %olume. # 'o identif$ factors that modif$ heart rate and stro&e %olume, and to indicate how the$ change cardiac output. Page 3. Cardiac Output Definition # Cardiac )utput (C)" * 'he %olume of blood ejected from the left or right %entricle into the aorta or pulmonar$ trun& per minute. # Cardiac output depends on: +. ,eart rate -. .tro&e %olume Cardiac Output CO = = Heart Rate HR X X Stroke Volume SV

Page 4. Heart Rate Definition # ,eart rate (,/" is the number of times the heart beats in one minute, a%eraging 01 beats per minute (bpm" in the adult at rest. Page 5. Stroke Volume Definition # .tro&e %olume (.2" is the amount of blood pumped b$ each %entricle with each heartbeat, a%eraging 03 ml per beat in the adult at rest. Page 6. SV = EDV - ESV # .tro&e %olume represents the difference between end diastolic %olume (E42" and end s$stolic %olume (E.2". # B$ the time diastole ends, each %entricle has filled up with blood. 'his amount of blood is the end diastolic volume or E42. # 'he amount of blood ejected during the s$stole is the stro&e %olume. 5t the end of s$stole the %olume of blood remaining in each %entricle is the end systolic volume or E.2. # Each %entricle normall$ contains about +-3 ml of blood b$ the end of diastole. 5t the end of s$stole about 13 ml of blood are left in each %entricle. 'his means that 03 ml of blood were pumped out of each %entricle during s$stole. Stroke Volume SV = ~70 ml/beat = = End-Diastolic Volume EDV ~ 120 ml/beat End-Systolic Volume ESV ~50 ml/beat

Page 7. Cardiac Output Demonstration

66 7et this animation run for a full minute until it is done.

each minute b$ the heart at rest ! about 1.-1 liters8

'his will gi%e $ou some appreciation for the amount of blood that is pumped

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# 'o get bac& to where $ou left off, clic& on the scrolling page list at the top of the screen and choose <=. /egulation of Cardiac )utput<.

Page 8. Regulation of Cardiac Output # 'he &e$ factor regulating stro&e %olume is the amount of stretching that occurs to %entricular cardiac muscle prior to %entricular contraction. 'he more cardiac muscle stretches, the more forcefull$ it contracts. 'hese stronger contractions increase stro&e %olume.

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Please note, there is a lot of important information on this page. Go through this page slowl$ and tr$ to ma&e sense of it.

Fill out this chart, making note of the reasons for the increase or decrease: Affect on Heart Rate Affect on Stroke Affect on Cardiac Volume Output Increased .$mpathetic .timulation Increased Paras$mpathetic .timulation Increased 2enous /eturn .low ,eart /ate E>tremel$ ?ast ,eart /ate E>ercise .udden 4rop in Blood Pressure /ising Blood Pressure .udden 4rop in Blood 2olume E>cess Calcium # Increased Sympathetic Stimulation ! Increased s$mpathetic stimulation (due to fright, anger, etc." increases the heart rate. It also increases stro&e %olume b$ increasing contractilit$, which results in more complete ejection of blood from the heart (lower E.2". # Increased Parasympathetic Stimulation ! Paras$mpathetic acti%it$ increases after a crisis has passed. 'his reduces heart rate and stro&e %olume from their high le%els, bringing cardiac output bac& to normal. # Increased Venous Return ! Cardiac muscle fibers are stretched b$ increased blood %olume returning to the heart (increased %enous return and E42". Increased stretch results in greater force of contraction, which increases stro&e %olume.

# Slo Heart Rate ! .low heart rate allows for more time for %entricular filling, increasing E42 and therefore stro&e %olume. # !"tremely #ast Heart Rate ! E>tremel$ rapid heart rate results in low %enous return and therefore decreased stro&e %olume. # !"ercise ! E>ercise acti%ates the s$mpathetic ner%ous s$stem, increasing heart rate, contractilit$, and stro&e %olume. Both the higher heart rate and s:uee(ing action of s&eletal muscles on %eins increase %enous return, contributing to increased stro&e %olume. # Sudden $rop in %lood Pressure ! 5 sudden drop in blood pressure results in low %enous return and therefore decreased stro&e %olume. ,owe%er heart rate increased due to s$mpathetic acti%it$, and normal cardiac output is maintained. # Risin& %lood Pressure ! /ising blood pressure reduces s$mpathetic acti%it$, decreasing heart rate. ,igh blood pressure also increases arterial pressure which %entricles must o%ercome before semilunar %al%es open, increasing E.2 and decreasing stro&e %olume. /educed cardiac output helps bring blood pressure down to normal le%els. # Sudden $rop in %lood Volume ! 5 sudden drop in blood %olume (eg. due to se%ere blood loss" results in low %enous return and therefore decreased stro&e %olume. .$mpathetic acti%it$ increases heart rate, maintaining cardiac output. # !"cess Calcium ! E>cess calcium can lead to spastic heart contractions, an undesirable condition. Calcium also increases stro&e %olume b$ enhancing contractilit$.

Page 9. Heart Videos # Effect of Epinephrine on a ?rog@s ,eart: Epinephrine is normall$ released when there is increased s$mpathetic acti%it$. # Effect of 5cet$l Choline on a ?rog@s ,eart: 5cet$l choline is a paras$mpathetic neurotransmitter. Page 10. Summary # Cardiac )utput * ,eart /ate A .tro&e 2olume # ,eart rate is increased b$ s$mpathetic ner%e acti%it$ and epinephrine. ,eart rate is decreased b$ paras$mpathetic ner%e acti%it$.

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Notes on Quiz Questions:

Quiz Question #1a: Cardiac Output # 'his :uestion as&s $ou to calculate cardiac output based on stro&e %olume and heart rate. If $ou get stuc&, remember the e:uation: Cardiac )utput * ,eart /ate A .tro&e 2olume 5lso remember that there are +333 milliliters in + liter. Quiz Question #1b: Soda Bottles # 'his :uestion as&s $ou to illustrate the cardiac output. Quiz Question #2: Heart Rate Regulation # 'his :uestion as&s $ou to predict what will happen to heart rate in %arious situations. Quiz Question #3: Stroke Volume Regulation # 'his :uestion as&s $ou to predict what will happen to stro&e %olume in %arious situations.

Study Questions on Cardiac Output:

+. (Page B." 4efine cardiac output. -. (Page B." Chat two factors does cardiac output depend onD B. (Page B." Chat is the mathematical relationship between cardiac output, heart rate, and stro&e %olume. E. (Page E." 4efine heart rate. 1. (Page E." Chat is the a%erage heart rate in an adult at restD F. (Page 1." 4efine stro&e %olume. 0. (Page 1." Chat is the a%erage stro&e %olume in an adult at restD =. (Page F." 4efine end diastolic %olume. G. (Page F." 4efine end s$stolic %olume. +3. (Page +3." Chat is the mathematical relationship between end diastolic %olume, end s$stolic %olume, and stro&e %olumeD ++. (Page F." If the E.2 is 13 ml and the E42 is +-3 ml, what is the stro&e %olumeD +-. Page 0." If the heart rate is 01 beats per minute and the stro&e %olume is 03 ml per beat, then what is the cardiac outputD +B. (Page =." Chat@s the relationship between cardiac muscle stretch and force of contractionD Chat effect does this ha%e on stro&e %olumeD +E. (Page =." Chat@s the relationship between %enous return and stro&e %olumeD +1. (Page =." Chat is the effect of increased s$mpathetic acti%it$ on heart rate and stro&e %olumeD ,ow does this effect cardiac outputD +F. (Page =." Chat is the effect of increased paras$mpathetic acti%it$ on heart rate and stro&e %olumeD +0. (Page =." Chat is the effect of increased %enous return on heart rate and stro&e %olumeD effect cardiac outputD +=. (Page =." Chat effect does a slow heart rate ha%e on stro&e %olumeD +G. (Page =." Chat effect does a fast heart rate ha%e on stro&e %olumeD -3. (Page =." Chat is the effect of e>ercise on heart rate and stro&e %olumeD ,ow does this effect cardiac outputD -+. (Page =." Chat is the relationship between blood pressure and s$mpathetic acti%it$D Chat effect does this ha%e on heart rateD --. (Page =." Chat is the effect of a sudden decrease in blood pressure on heart rate and stro&e %olumeD -B. (Page =." Chat is the effect of a sudden increase in blood pressure on heart rateD -E. (Page =." Chat is the effect of a sudden increase in blood pressure on stro&e %olumeD -1. (Page =." Chat is the effect of a sudden drop in blood %olume on heart rate and stro&e %olumeD -F. (Page =." Chat is the effect of an increase in calcium on heart rate and stro&e %olumeD ,ow does this