THE CARDIAC RESERVE and CARDIAC WORK by Dr.

Doaa Samy

Objectives:

Define cardiac work Define mechanical efficiency of the heart. Define cardiac reserve, List its parameters and limitations. Explain the mechanism of cardiac reserve Explain why trained athletes can achieve higher cardiac output than non athletes can do List the types of work done by the heart Describe mechanical efficiency of the heart

The cardiac work

f energy that the heart converts to work while

The cardiac work

p a certain volume of blood against the arter

pressure output X pressure volume X volume work / min = cardiac mean BP volume work / beat = stroke mean BP

The cardiac work

g meter/minute at rest, and right work which is

The cardiac work

stream . It is about 2% of the total work done

The cardiac work

e heart during rest = 6+ 1+ 0.14 =

The mechanical efficiency of the heart (M E)

The mechanical efficiency of the heart (M E)

The mechanical efficiency of the heart (M E)

Cardiac reserve
The cardiac reserve is the ability of the heart to increase its work and output when required (e.g. during muscular exercise).

Cardiac reserve
Cardiac reserve is the difference between the work of the heart in a maximum activity and its work under basal condition.

Definition

Cardiac reserve
The work of the heart during maximal activity (muscular exercise) increases up to 13 folds the cardiac work at rest due to:

The mechanisms of cardiac reserve

But each mechanism has its

The mechanisms of cardiac reserve 1- Heart rate reserve

The heart rate is increased through the following mechanisms: 1- Increased sympathetic activity. 2- Increased venous return with stimulation of the right atrial stretch receptors and direct stimulation of the SAnode. 3- Increased body temperature. 4- others.

rate reserve limitation

Excessive increase in the heart rate Shortens the diastolic time

1- decreases cardiac filling and stroke volum 2- decreases coronary perfusion

The mechanisms of cardiac reserve 2 - stroke volume reserve

The force of contraction and so the stroke volume can be incr eased through the following mechanisms

1- cardiac dilatation

Dilatation of the heart by venous return EDV better systole (= Starling s Law ) ESV .

2 - sympathetic stimulation

More efficient emptying of the ventricles ESV .

Cardiac dilatation
Preload Frank-Starling Law of the Heart
Length tension relationship of heart Length = EDV Tension = SV

As the ventricles become overfilled, the heart becomes inefficient and stroke volume declines. cardiac reserve

ympathetic Stimulation

Positive Inotropic Effect

increase the force of contracti on without changing the length of the cardiac muscle

o lu m e reserve limitation
Excessive increase in the EDV Over stretching of myocardial fibers

Decrease the force of myocardial contractio

The mechanisms of cardiac reserve hypertrophy of the cardiac muscle

Increased size of each ventricular cell occurs when the heart is exposed to prolonged and sustained load which may be either: 1- Physiological cardiac hypertrophy 2- Pathological cardiac

The mechanisms of cardiac reserve hypertrophy of the cardiac muscle

1- Physiological cardiac hypertrophy
bulk of the heart muscle power of

cardiac contraction stroke volume.

Hypertrophy is accompanied by dilatation

EDV stroke volume

LEFT VENTRICULAR HYPERTROPHY

ypertrophy reserve limitation

ophy of the heart without corresponding increase

Ischemia of the cardiac muscle due to inadequate

hypertrophy of the cardiac muscle

2- Pathological cardiac hypertrophy
a)

Left ventricular hypertrophy

c)

Right ventricular hypertrophy

Not a reserve

The mechanisms of cardiac reserve

. The mechanisms of cardiac reserve occur only

during muscular exercise in normal hearts. However, in a diseased heart some of these mechanisms may be used during rest.

Cardiac output (L/min) Non-athlete Rest 5

Heart rate (beat/min)

Stroke EDV(ml) ESV (ml) volume (ml)

70 180 (*2.5)

70 120 (*1.7)

130

60

Maximum 22 exercise Trained athlete Rest 5

140 (+10) 20 (- 40)

40 180 (*4.5)

120 200(*1.6)

200

80

Maximum 36 exercise

220(+20) 20 ( -60)

COP

HR 70-75

SV 70

EDV 130

ESV 60

Non athlete 5 At rest

Max. exercise

22-25

180

120

140

20

Trained athlete At rest

40

120

200

80

Max. exercise

35-35

180

200

220

20

Conclusions

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