1 Cardiac output and Venous Return Faisal I. Mohammed, MD, PhD.

Slides:



Advertisements
Similar presentations
CARDIAC OUTPUT.
Advertisements

Cardiac Output Prof. K. Sivapalan 2013 Cardiac output.
Dr. Khurram Irshad. Cardiac Output “Amount of blood pumped out by each ventricle in each minute” Cardiac Output = Stroke volume X H.R.
CARDIAC OUTPUT DR. EMAN EL ETER PHYSIOLOGY DEP. Definitions Cardiac output (CO): Amount of blood pumped by each ventricle per minute. Stroke volume (SV):
Circulatory Adaptations to Exercise
Cardiac Output: And Influencing Factors. Cardiac Output Amount of blood pumped out by each ventricle in 1 min CO = HR x SV.
C h a p t e r 20 The Heart PowerPoint® Lecture Slides prepared by Jason LaPres Lone Star College - North Harris Copyright © 2009 Pearson Education, Inc.,
 By the end of this lecture the students are expected to:  Define cardiac output, stroke volume, end- diastolic and end-systolic volumes.  Define physiological.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 43 Review of Hemodynamics.
Chapter 20, part 3 The Heart.
Cardiac output and venous return. Cardiac output The quantity of blood pumped into the aorta –Amount of blood that flows through the circulation –Most.
Cardiovascular Physiology
First, finish the material from last week…. In skeletal muscle, a higher frequency of action potentials leads to a greater amount of tension Figure 2.
Regulation and Integration
Chapter 15 Assessment of Cardiac Output
Cardiac output and Venous Return
Copyright © 2006 by Elsevier, Inc. Lymphatic System.
MODULE F – HEMODYNAMIC MONITORING. Topics to be Covered Cardiac Output Determinants of Stroke Volume Hemodynamic Measurements Pulmonary Artery Catheterization.
Cardiovascular System
CARDIAC OUTPUT & VENOUS RETURN
Introduction to Cardiac Cycle and Cardiac Output
The Effect of Exercise on the Cardiovascular System
C h a p t e r 20 The Heart PowerPoint® Lecture Slides prepared by Jason LaPres Lone Star College - North Harris Copyright © 2009 Pearson Education, Inc.,
Cardiovascular Dynamics During Exercise
Cardiac Output When the heart contracts Cardiac Vocabulary Contractility: Contractility is the intrinsic ability of cardiac muscle to develop force for.
2013 Cardiac output 1 Cardiac Output Prof. K. Sivapalan.
Control of the Circulation Control of the circulation depends on a variety of mechanisms that are directly related to the specific functions that the circulation.
Regulation of stroke volume & heart rate Measurement of cardiac output Regulation of heart rate –neural Regulation of stroke volume –Preload –Afterload.
1 Heart Pump and Cardiac Cycle Faisal I. Mohammed, MD, PhD.
CARDIAC AND VASCULAR FUNCTION CURVES.. Figure Length-force relationships in intact heart: a Frank-Starling curve Optimal Length.
Components of the Circulation
Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Understanding EKGs: A Practical Approach, Third Edition.
Cardiovascular System and Exercise
Chapter 9: Circulatory Adaptations to Exercise
Frank-Starling Mechanism
Cardiovascular Anatomy and Physiology AFAMS Residency Orientation April 16, 2012 ARMED FORCES ACADEMY OF MEDICAL SCIENCES.
Dr.Mohammed Sharique Ahmed Quadri Assistant professor ,Physiology
 By the end of this lecture the students are expected to:  Define cardiac output, stroke volume, end- diastolic and end-systolic volumes.  Define.
Dr.Mohammed Sharique Ahmed Quadri Assistant professor ,Physiology
CHAPTER 4 THE CARDIOVASCULAR SYSTEM Weight of the heart 300g Work: 75/min, beats /day 35 million beats /year, 2.5 billion beats/life 70ml/beat,
Cardiac Output. Cardiac output The volume of blood pumped by either ventricle in one minute The output of the two ventricles are equal over a period of.
The Cardiac Cycle. The repeating pattern of contraction (systole) and relaxation (diastole) of the heart The repeating pattern of contraction (systole)
Cardiovascular Physiology
PRINCIPLES OF HUMAN PHYSIOLOGY THIRD EDITION Cindy L. Stanfield | William J. Germann PowerPoint ® Lecture Slides prepared by W.H. Preston, College of the.
Cardiac Output, Venous Return, & Their Regulation
The Cardiac Cycle. The repeating pattern of contraction (systole) and relaxation (diastole) of the heart The repeating pattern of contraction (systole)
1 1 Cardiac output and Venous Return Faisal I. Mohammed, MD, PhD.
Chapter 14 Dr. D. Washington. Cardiac Output I. Definition: C.O. (L/min)= heart rate X stroke volume or(ml/min) (beats/min)(ml/beat) II. Cardiac Index.
© 2015 Pearson Education, Inc. Figure Pressure and Volume Relationships in the Cardiac Cycle. Aorta Electro- cardiogram (ECG) QRS complex P T ONE.
Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Ch. 20 The Heart Describe the organization of the cardiovascular system. Discuss.
Cardiovascular System
Cardiac Output April 28, 2017 Cardiac Output.
The cardiovascular system The heart. RENAL-BODY FLUID CONTROL SYSTEM CARDIOVASCULAR SYSTEM HEART (PUMP) VESSELS (DISTRIBUTION SYSTEM) REGULATION AUTOREGULATION.
University of Jordan 1 Cardiovascular system- L4 Faisal I. Mohammed, MD, PhD.
1 Topics to be addressed: Blood Anatomy of Blood Vessels Anatomy of the Heart The Conduction System The Cardiac Cycle Cardiodynamics Blood Flow and its.
Heart Pump and Cardiac Cycle
Cardiac output and Venous Return
Factors that effect EDV and ESV
Cardiac Output, Venous Return, and Their Regulation
Control of blood tissue blood flow
Cardiac Output And Hemodynamic Measurements
Cardiac Physiology Class 1.
Cardiac output and venous return
Cardiac Physiology Pt 2 Pramod Chandru.
Blood Pressure Regulation
When the heart contracts
2 Cardiovascular Physiology: Function.
Factors affecting cardiac output
Cardiovascular system- L4
Cardiovascular system- L4
Presentation transcript:

1 Cardiac output and Venous Return Faisal I. Mohammed, MD, PhD

2 Objectives Define cardiac output and venous return Describe the methods of measurement of CO Outline the factors that regulate cardiac output Follow up the cardiac output curves at different physiological states Define venous return and describe venous return curve Outline the factors that regulate venous return curve at different physiological states Inter-relate Cardiac output and venous return curves

3 Cardiac Output is the sum of all tissue flows and is affected by their regulation (CO = 5L/min, cardiac index = 3L/min/m 2 ). CO is proportional to tissue O 2. use. CO is proportional to 1/TPR when AP is constant. F=  P/R (Ohm’s law) CO = (MAP - RAP) / TPR, (RAP=0) then CO=MAP/TPR ; MAP=CO*TPR Important Concepts About Cardiac Output (CO) Control

CARDIAC OUTPUT (L/min/m) CARDIAC OUTPUT OXYGEN CONSUMPTION (L/min) O 2 CONSUMPTION WORK OUTPUT DURING EXERCISE (kg*m/min) OLYMPIC ATHLETE COUCH POTATO Copyright © 2006 by Elsevier, Inc.

5 Magnitude & Distribution of CO at Rest & During Moderate Exercise

6 Variations in Tissue Blood Flow Brain Heart Bronchi Kidneys Liver Portal (21) (1050) Arterial (6) (300) Muscle (inactive state) Bone Skin (cool weather) Thyroid gland Adrenal glands Other tissues Total Per cent ml/min ml/min/ 100 gm

7 Control of Cardiac Output

8 Factors that affect the Cardiac Output

NORMAL HYPEREFFECTIVE CARDIAC OUTPUT (L/min) RIGHT ATRIAL PRESSURE (mmHg) HYPOEFFECTIVE CARDIAC OUTPUT CURVES

Cardiac Output curve (Plateau curve)

CARDIAC OUTPUT (L/min) RIGHT ATRIAL PRESSURE (mmHg) IPP= -4mmHg IPP= -2mmHg IPP = INTRAPLEURAL PRESSURE IPP= -5.5mmHg IPP= 2mmHg CARDIAC TAMPONADE

12 Plateau of CO curve determined by heart strength (contractility +  HR)  Sympathetics  plateau  Parasympathetics (HR  )  plateau)  Plateau Heart hypertrophy  ’s plateau Myocardial infarction  plateau)  Plateau The Cardiac Output Curve

13 Valvular disease   plateau (stenosis or regurgitation) Myocarditis   plateau Cardiac tamponade  plateau)  Plateau Metabolic damage   plateau The Cardiac Output Curve (cont’d)

Factors Affecting Cardiac Output

Factors Affecting Stroke Volume Contractility of Muscle cells Cont = ESV

A Summary of the Factors Affecting Cardiac Output

17 REGULATION OF STROKE VOLUME: PRELOAD decreased heart rate increased length of diastole increased ventricular filling increased venous pressure increased venous return increased ventricular filling increased preload increased ventricular stretch Frank-Starling mechanism increased force of contraction increased stroke volume increased cardiac output

18 REGULATION OF STROKE VOLUME: CONTRACTILITY increased sympathetic activity increased epinephrine other factors increased contractility increased force of contraction increased stroke volume increased cardiac output

19 REGULATION OF STROKE VOLUME: AFTERLOAD increased arterial pressure increased afterload decreased blood volume ejected into artery decreased stroke volume decreased cardiac output

20 Electromagnetic flowmeter Indicator dilution (dye such as cardiogreen) Thermal dilution Oxygen Fick Method CO = (O 2 consumption / (A-V O 2 difference) Measurement of Cardiac Output

21 Electromagnetic flowmeter

q 1 =CO*C VO2 q 2 =amount of Oxygen uptake by the lungs q 3 = CO* C AO2 and equals = CO*C VO2 + O 2 uptake Oxygen uptake = CO{C AO2 -C VO2 } CO=Oxygen uptake/{C AO2 -C V O2 }

23 Spirometer

24 Swan-Ganz catheter

25 O 2 Fick Problem If pulmonary vein O 2 content = 200 ml O 2/ L blood Pulmonary artery O 2 content = 160 ml O 2 /L blood Lungs add 400 ml O 2 /min What is cardiac output? Answer: 400/( ) =10 L/min

Area = t2t2 t1t1 Area = C* (t 2 -t 1 ) (Rectangular) C =Area /( t 2 - t 1 ) Cardiac output =

Thermodilution Method Curve AREA = t1t2

28 Effect of Venous Valves

29 Effect Of Gravity on Venous Pressure

30 Venous Pressure in the Body Compressional factors tend to cause resistance to flow in large peripheral veins. Increases in right atrial pressure causes blood to back up into the venous system thereby increasing venous pressures. Abdominal pressures tend to increase venous pressures in the legs.

31 Central Venous Pressure  Pressure in the right atrium is called central venous pressure.  Right atrial pressure is determined by the balance of the heart pumping blood out of the right atrium and flow of blood from the large veins into the right atrium.  Central venous pressure is normally 0 mmHg, but can be as high as mmHg.

32 Factors affecting Central Venous Pressure  Right atrial pressure (RAP) is regulated by a balance between the ability of the heart to pump blood out of the atrium and the rate of blood flowing into the atrium from peripheral veins.  Factors that increase RAP:  -increased blood volume  -increased venous tone  - dilation of arterioles  -decreased cardiac function

33 Effect of Venous Valves

34 Venous Valves Valve Deep vein Perforating vein Superficial vein

35 Factors that Facilitate Venous Return

RIGHT ATRIAL PRESSURE (mmHg) VENOUS RETURN (L/MIN) MSFP= 7 MSFP= 14 MSFP= 4.2 MSFP = Mean Systemic Filling Pressure The Venous Return Curve

VENOUS RETURN (L/min/m) RIGHT ATRIAL PRESSURE (mmHg) MSFP = 7 NORMAL RESISTANCE 1/2 RESISTANCE2 X RESISTANCE

38 Beriberi - thiamine deficiency  arteriolar dilatation   RVR because VR = (MSFP - RAP) /RVR (good for positive RAP’s) A-V fistula  (? RVR)  RVR C. Hyperthyroidism  (? RVR)  RVR Venous Return (VR)

39 Anemia   RVR (why?)  Sympathetics   MSFP  Blood volume   MSFP + small  in RVR  Venous compliance (muscle contraction or venous constriction)  SFP)  MSFP Venous Return (VR) (cont’d)

40  Blood volume   MSFP  Sympathetics  (? v. comp. and MSFP)  Venous compliance and  MSFP Obstruction of veins  (? RVR)  RVR Factors Causing  Venous Return

CARDIAC OUTPUT AND VENOUS RETURN (L/min/m) RIGHT ATRIAL PRESSURE (mmHg) NORMAL CARDIAC VR CURVE NORMAL SPINAL ANESTHESIA SPINAL ANESTHESIA MAXIMAL SYMPATHETIC STIMULATION SYMPATHETIC STIMULATION MAX

Thank You