Escolar Documentos
Profissional Documentos
Cultura Documentos
Dr. M. N. Afzal
Arterial Venous
Determinants of CO
Two determinants of CO are:
x stroke volume
(70 ml / beat)
ml / min
Cardiac Output
Cardiac Index
CO per square meter area of the body
Cardiac Reserve
Difference between CO at rest and maximum volume of blood
Control of CO
CO =
1.
Heart rate:
-Parasympathetic NS -Sympathetic NS -Epinephrine
2.
Stroke volume:
-Intrinsic control -Extrinsic control -Sympathetic NS -NE & Epinephrine
Contractility
(Frank-Starling law)
1. Intrinsic control Preload (EDV) Afterload (R) 2. Extrinsic control Sympathetic NS Epinephrine
Stroke Volume
Stroke Volume
Two control systems influence SV
Intrinsic control
Influenced by:
End-diastolic volume (preload)
Total peripheral resistance (afterload)
Intrinsic control
Frank-Starling Law Intrinsic relationship between EDV & SV (Heart pumps all the blood returned to it) A built-in / intrinsic property of heart muscle Increased EDV results in increased SV Length-tension relationship
Intrinsic control of SV
(FrankStarling Curve)
(FrankStarling Curve)
Advantages Equalization of output between right and left side of the heart When larger output is needed, increase in venous return automatically increases stroke volume correspondingly
Extrinsic control of CO
Sympathetic NS Epinephrine
Strengthens cardiac contractility (Shifts Frank-Starling curve to left) Enhances venous return
ANS control of SV
Control of CO summary
Afterload
Workload imposed on heart Heart compensates by enlarging (hypertrophy) Sustained extra workload eventually leads to
Heart Failure
Heart Failure
Inability to keep pace with demands of body Most common causes:
Myocardial infarction Hypertension (sustained elevated BP) Stenotic semilunar valves
Normal stroke volume Decrease in stroke volume Stroke volume with uncompensated heart failure
Failing heart
Acute compensation
Backward failure:
Blood cannot be pumped out Blood start accumulating in the venous system
Question
A volume-pressure diagram of the left ventricle during one cardiac cycle of a normal heart is shown above. Which point on the diagram marks the beginning of ventricular diastole? A. A B. B C. C D. D E. E
Question
A volume-pressure diagram of the left ventricle during one cardiac cycle of a normal heart is shown above. Which points on the diagram marks the systolic phase? A. ABC B. BCD C. CDA D. DAB