p.13
Factors Influencing Venous Return
What happens to intrathoracic pressure during inspiration?
It becomes more negative.
What is ventricular compliance?
The distensibility of the ventricle.
p.18
Afterload and its Effects
What is afterload?
The 'load' that the heart must eject blood against.
p.19
Afterload and its Effects
What primarily determines afterload?
Vessel diameter and viscosity of blood.
p.15
Myocardial Contractility (Inotropy)
How does sympathetic stimulation affect ventricular contractility?
It increases ventricular contractility.
p.2
Significance of Cardiac Output
What does cardiac output represent?
The total quantity of blood available for providing adequate tissue perfusion.
p.8
Determinants of Cardiac Output
What does venous return to the heart consist of?
The sum of all the local blood flows from individual segments of peripheral circulation.
What does filling time refer to?
The duration of ventricular diastole.
p.22
Heart Rate and Cardiac Output
How does heart rate affect cardiac output?
The number of times the heart beats per minute influences the amount of blood pumped out per minute.
p.1
Calculation of Cardiac Output
How is Stroke Volume calculated?
Stroke Volume = End Diastolic Volume (EDV) - End Systolic Volume (ESV).
p.25
Cardiac Index and its Calculation
What does Cardiac Index (CI) measure?
It measures cardiac output relative to body surface area.
p.4
Calculation of Cardiac Output
What is stroke volume?
The amount of blood pumped by the heart with each beat.
p.27
Calculation of Cardiac Output
What is cardiac output?
The volume of blood the heart pumps per minute.
What is preload in the context of cardiac function?
Preload is the initial stretching of the cardiac myocytes prior to contraction, related to sarcomere length.
p.11
Factors Influencing Venous Return
How does increased blood volume affect venous return?
It increases venous return.
How does atrial contraction affect ventricular preload?
It contributes to the filling of the ventricles.
p.1
Calculation of Cardiac Output
What is the approximate Cardiac Output calculated in the example?
Cardiac Output = 5.6 L/min.
p.19
Afterload and its Effects
How does increased peripheral resistance affect stroke volume?
It decreases stroke volume.
What happens to the force of contraction after a certain extent of stretching?
Further stretching decreases the force of contraction.
p.25
Cardiac Index and its Calculation
What is the formula for calculating Cardiac Index (CI)?
CI = Cardiac output divided by body surface area in square meters.
p.1
Calculation of Cardiac Output
If EDV is 130 and ESV is 50, what is the Stroke Volume?
Stroke Volume = 130 - 50 = 80.
p.11
Factors Influencing Venous Return
What causes peripheral pooling of blood?
Standing posture and gravity.
p.12
Factors Influencing Venous Return
What is the role of the muscle pump?
Responsible for the flow of blood from the veins of the limbs to the heart.
p.21
Heart Rate and Cardiac Output
What is the effect of heart rate on cardiac output?
The number of times the heart beats per minute influences the amount of blood pumped out per minute.
p.13
Factors Influencing Venous Return
What anatomical movement occurs during inspiration that affects venous return?
Descent of the diaphragm.
p.16
Myocardial Contractility (Inotropy)
What is the effect of increased inotropy on force generation?
It results in increased force generation, independent of preload and afterload.
p.16
Myocardial Contractility (Inotropy)
What happens to the amount of blood pumped out when inotropy increases?
More blood can be pumped out.
p.21
Heart Rate and Cardiac Output
How do oxygen and carbon dioxide levels affect heart rate?
Mild hypoxia causes an increase in heart rate.
p.22
Heart Rate and Cardiac Output
What happens to cardiac output when heart rate increases?
Cardiac output is expected to increase.
p.15
Myocardial Contractility (Inotropy)
What is the effect of changes in myocardial contractility on stroke volume?
It causes changes in the amount of blood pumped out in one beat.
What is preload in relation to cardiac output?
Preload refers to the filling pressure of the ventricles, influenced by various factors.
p.10
Factors Influencing Venous Return
How does venous pressure affect venous return?
Venous pressure influences the amount of blood returning to the heart.
p.21
Heart Rate and Cardiac Output
How does an increase in heart rate affect cardiac output?
It may increase the cardiac output.
p.10
Factors Influencing Venous Return
What happens to venous pressure in smaller and larger veins?
The pressure gradually decreases.
What is preload?
The degree of stretch of the heart muscle before contraction.
p.17
Myocardial Contractility (Inotropy)
What is the impact of loss of myocardium on contractility?
Loss of myocardium negatively affects myocardial contractility.
p.21
Heart Rate and Cardiac Output
What other factors can influence heart rate?
Drugs can also influence heart rate.
p.2
Significance of Cardiac Output
Why must cardiac output be maintained at a certain level?
To meet the requirements of the body.
p.1
Calculation of Cardiac Output
What is the formula for calculating Cardiac Output?
Cardiac Output = Stroke Volume x Heart Rate.
p.25
Cardiac Index and its Calculation
What is the approximate Cardiac Index (CI) at rest for a cardiac output of 5 L/min and a body surface area of 1.7 m²?
Approximately 3 L/min/m².
p.1
Calculation of Cardiac Output
What is the Heart Rate in the given calculation?
Heart Rate = 70 beats per minute.
p.18
Afterload and its Effects
What does peripheral resistance refer to?
The resistance offered against ejection of blood from ventricles.
p.24
Determinants of Cardiac Output
What factors affect venous return?
Filling pressure, ventricular distensibility, filling time, and atrial contraction.
p.24
Myocardial Contractility (Inotropy)
What is inotropy?
Inotropy refers to the strength of myocardial contraction.
p.17
Myocardial Contractility (Inotropy)
What role do circulating catecholamines play in myocardial contractility?
They act as positively inotropic agents, increasing myocardial contractility.
p.17
Determinants of Cardiac Output
How do oxygen and carbon dioxide levels affect myocardial contractility?
Moderate to severe hypoxia decreases cardiac output by directly suppressing myocardial contractility, while carbon dioxide depresses the myocardium.
What happens to the Frank-Starling curve following stimulation of sympathetic nerves to the heart?
It shifts upward and to the left.
p.28
Factors Influencing Venous Return
Why does cardiac output increase during inspiration?
Due to increased venous return and decreased intrathoracic pressure.
p.28
Heart Rate and Cardiac Output
What occurs to cardiac output when heart rate exceeds 200 bpm?
It decreases due to reduced filling time.
What does the Frank-Starling Law state?
The force of contraction increases when the initial length of the muscle increases.
How is ventricular preload determined?
By the volume of blood that fills the ventricle at the end of passive filling and atrial contraction, known as End Diastolic Volume (EDV).
p.11
Factors Influencing Venous Return
What effect does gravity have on venous return?
It can decrease venous return when standing due to peripheral pooling of blood.
p.15
Myocardial Contractility (Inotropy)
What are factors that increase myocardial contractility called?
Positively inotropic factors.
What role does preload play in cardiac function?
Preload refers to the initial stretching of the cardiac muscle fibers before contraction, influencing stroke volume.
p.19
Afterload and its Effects
What is the effect of increased viscosity (polycythemia) on peripheral resistance?
It increases peripheral resistance.
p.17
Myocardial Contractility (Inotropy)
How does autonomic nervous activity affect myocardial contractility?
Stimulation of sympathetic nerves increases heart rate and myocardial contractility, which raises cardiac output.
p.17
Myocardial Contractility (Inotropy)
What effect does acidosis have on myocardial contractility?
Acidosis depresses myocardial contractility due to increased H+ ion concentration.
p.16
Myocardial Contractility (Inotropy)
How does increased inotropy affect end-systolic volume (ESV) and stroke volume (SV)?
It causes a reduction in ESV and an increase in SV.
p.16
Myocardial Contractility (Inotropy)
What is the relationship between inotropy and ejection fraction (EF)?
Increasing inotropy leads to an increase in EF, while decreasing inotropy decreases EF.
What is the effect on the Frank-Starling curve when afterload increases?
The Frank-Starling curve shifts down and to the right.
p.26
Determinants of Cardiac Output
How do sympathetic and parasympathetic stimulation affect the heart?
Sympathetic stimulation increases heart rate and contractility, while parasympathetic stimulation decreases heart rate.
p.28
Afterload and its Effects
What is the effect of increased afterload on cardiac output?
It decreases cardiac output.
p.3
Determinants of Cardiac Output
How does heart rate affect cardiac output?
An increase in heart rate typically increases cardiac output.
What is heterometric autoregulation?
It refers to the variation of stroke volume at different ventricular muscle lengths.
What happens to muscle fibers when preload increases?
An increase in preload (increase in EDV) causes an increase in the initial length of the muscle fibers.
p.15
Myocardial Contractility (Inotropy)
What are factors that decrease myocardial contractility called?
Negatively inotropic factors.
p.4
Myocardial Contractility (Inotropy)
How does myocardial contractility (inotropy) affect cardiac output?
Increased myocardial contractility enhances the heart's ability to pump blood, increasing stroke volume.
p.15
Myocardial Contractility (Inotropy)
What is the effect of vagal stimulation on myocardial contractility?
It has less effect on myocardial contractility.
p.12
Factors Influencing Venous Return
What happens to the valves during muscle contraction?
The valve proximal to the contracting muscle opens, while the distal valve closes.
p.12
Factors Influencing Venous Return
What is the result of the muscle pump action?
Blood is propelled up towards the heart.
p.24
Determinants of Cardiac Output
What role does oxygen supply play in cardiac output?
Oxygen supply is essential for the functioning myocardium, affecting cardiac output.
p.27
Determinants of Cardiac Output
What is end systolic volume?
The volume of blood remaining in the ventricles after contraction (systole).
p.28
Myocardial Contractility (Inotropy)
What effect does an increase in inotropy have on cardiac output?
It increases cardiac output.
p.3
Determinants of Cardiac Output
What is cardiac output?
The volume of blood the heart pumps per minute.
p.23
Determinants of Cardiac Output
How does changing from lying to sitting or standing affect cardiac output?
Decreases it by 20 – 30%.
p.18
Afterload and its Effects
How does afterload affect ventricular work?
Higher afterload results in higher ventricular work.
p.19
Afterload and its Effects
What effect does a decrease in vessel diameter (vasoconstriction) have on peripheral resistance?
It increases peripheral resistance.
p.12
Factors Influencing Venous Return
What happens when skeletal muscles contract?
Deep veins present between the muscles are compressed.
p.12
Factors Influencing Venous Return
What occurs to the pressure in the veins during muscle contraction?
Increased pressure in the compressed veins.
p.24
Afterload and its Effects
What factors contribute to afterload?
Aortic pressure and systemic arteriolar resistance.
p.24
Heart Rate and Cardiac Output
How does heart rate influence cardiac output?
Heart rate is influenced by the autonomic nervous system and circulating catecholamines.
p.27
Afterload and its Effects
What is afterload?
The resistance the heart must overcome to eject blood.
p.27
Determinants of Cardiac Output
What is end diastolic volume?
The volume of blood in the ventricles at the end of filling (diastole).
p.3
Determinants of Cardiac Output
What are the primary determinants of cardiac output?
Heart rate and stroke volume.
p.15
Myocardial Contractility (Inotropy)
What is the effect of sympathetic inhibition on ventricular contractility?
It decreases ventricular contractility.
p.4
Afterload and its Effects
What is afterload?
The resistance the heart must overcome to eject blood during systole.
p.27
Calculation of Cardiac Output
What is stroke volume?
The amount of blood pumped by the heart with each beat.
p.27
Calculation of Cardiac Output
What is ejection fraction?
The percentage of blood ejected from the heart during each contraction.
p.20
Afterload and its Effects
What happens to end-systolic volume when afterload increases?
End-systolic volume increases.
What is ventricular preload?
The degree of stretch of the ventricles at the end of diastole.
p.16
Myocardial Contractility (Inotropy)
Why is ejection fraction (EF) used clinically?
It is used as a clinical index for evaluating the inotropic state of the heart.
p.26
Determinants of Cardiac Output
What are the two major factors that determine cardiac output?
Heart rate and stroke volume.
p.3
Determinants of Cardiac Output
What is preload?
The degree of stretch of the heart muscle before contraction, affecting stroke volume.
p.19
Afterload and its Effects
What is the relationship between increased viscosity and cardiac output?
Increased viscosity decreases cardiac output.
p.21
Heart Rate and Cardiac Output
What autonomic nervous activity influences heart rate?
Stimulation of sympathetic nerves increases heart rate, while stimulation of the vagus nerve decreases it.
p.21
Heart Rate and Cardiac Output
What role do circulating catecholamines play in heart rate?
They have a positive chronotropic effect, increasing heart rate.
What is indicated by the 'descending limb' of the Frank-Starling curve?
Points where maximum contractility has been exceeded.
p.17
Myocardial Contractility (Inotropy)
How does digitalis affect myocardial contractility?
Digitalis increases myocardial contractility.
p.9
Factors Influencing Venous Return
How does venous blood pressure influence ventricular preload?
Higher venous blood pressure increases venous return, enhancing preload.
p.9
Factors Influencing Venous Return
How does gravity affect venous return?
Gravity can hinder venous return from the lower body, affecting preload.
p.26
Determinants of Cardiac Output
What is the normal value of stroke volume?
Approximately 70 mL per beat.
p.3
Determinants of Cardiac Output
What role does stroke volume play in cardiac output?
Stroke volume is the amount of blood ejected with each heartbeat, directly influencing cardiac output.
What happens to the Frank-Starling curve when myocardial contractility decreases?
The curve shifts downward and to the right.
What do the dashed lines on the Frank-Starling curve represent?
Portions of the ventricular function curves where maximum contractility has been exceeded.
p.10
Factors Influencing Venous Return
What role does the pressure gradient in the venous tree play?
It acts as a driving force for venous return.
What does Frank Starling's curve illustrate?
The relationship between stroke volume and end-diastolic volume.
p.26
Determinants of Cardiac Output
What is the normal value of heart rate?
Approximately 60-100 beats per minute.
p.26
Calculation of Cardiac Output
Define cardiac output.
The volume of blood the heart pumps per minute.
p.3
Determinants of Cardiac Output
How does myocardial contractility affect cardiac output?
Increased contractility enhances stroke volume, thereby increasing cardiac output.
p.28
Heart Rate and Cardiac Output
How does an increase in heart rate affect cardiac output?
It generally increases cardiac output, up to a certain point.
What does the Frank-Starling Law state?
The stroke volume of the heart increases in response to an increase in the volume of blood filling the heart.
p.9
Factors Influencing Venous Return
What is the respiratory pump?
The respiratory pump facilitates venous return through pressure changes during breathing.
p.3
Determinants of Cardiac Output
What factors can influence stroke volume?
Preload, afterload, and myocardial contractility.
p.27
Cardiac Index and its Calculation
What is cardiac index?
Cardiac output adjusted for body surface area, indicating the efficiency of the heart.
How does an increase in preload affect cardiac output?
It increases cardiac output.
p.26
Calculation of Cardiac Output
What is the normal value of cardiac output?
Approximately 4-8 liters per minute.
p.3
Determinants of Cardiac Output
What is afterload?
The resistance the heart must overcome to eject blood, impacting stroke volume.
p.9
Factors Influencing Venous Return
What role does blood volume play in determining ventricular preload?
Increased blood volume raises venous return, thus increasing preload.
p.9
Factors Influencing Venous Return
What is the muscle pump and how does it influence venous return?
The muscle pump aids venous return by compressing veins during muscle contraction.
p.26
Determinants of Cardiac Output
What are four major factors that determine cardiac output?
Preload, afterload, myocardial contractility, and heart rate.
p.23
Determinants of Cardiac Output
What role does epinephrine play in cardiac output?
It increases cardiac output.
