Stroke Volume and Cardiac Output

FBS Program Medical Faculty Universitas Islam Bandung

Stroke Volume
Stroke volume is governed by three factors called preload, contractility, and afterload. Increased preload or contractility increases stroke volume. Increased afterload opposes the emptying of the ventricles and reduces stroke volume.

Stroke Volume
Preload:
Preload is the tension in the ventricular myocardium immediately before it contracts The tension is evoked by stretching of myocardium The stretching is increased by increased venous return The more increase the stretching the more increased the preload the more forcefully the myocardial contration The more forcefully the contraction the more increased the stroke volume (FrankStarling law of the heart)

Stroke Volume
Contractility
The contractility of the myocardium refers to its contraction force for a given preload. Factors that increase contractility are called positive inotropic agents, and those that reduce it are negative inotropic agents. The vagus nerves have a negative inotropic effect on the atria, but they provide so little innervation to the ventricular myocytes that they have little effect on the ventricles. Hyperkalemia has a negative inotropic effect because it reduces the strength of myocardial action potentials and thus reduces the release of Ca2+ into the sarcoplasm. The heart becomes dilated and flaccid. Hypokalemia, however, has little effect on contractility.

Stroke Volume
Afterload
The afterload is the pressure just outdisde the semilunar valve opposes the opening these valves An increased afterload therefore reduces stroke volume. Anything that impedes arterial circulation can increase the afterload. For example, scar tissue in the lungs restricts pulmonary circulation increases the afterload in the pulmonary trunk and opposes emptying of the right ventricle the ventricle works harder it gets larger like any other muscle. Stress and hypertrophy of a ventricle can eventually cause it to weaken and fail. Right ventricular failure due to obstructed pulmonary circulation is called cor pulmonale. It is a common complication of emphysema, chronic bronchitis, and black lung disease.

Cardiac Output
Cardiac output (CO) is the amount of ejected blood by each ventricle in one minute. CO = HR x SV Cardiac output is not constant but varies with the bodys state of activity. Vigorous exercise increases CO to as much as 21 L/min in a person in good condition and up to 35 L/min in world-class athletes. The difference between the maximum and resting cardiac output is called cardiac reserve. The larger the cardiac reserve the higher the tolerance of physical exertion

Heart Rate
The newborn resting heart rate is commonly 120 bpm or greater. In young adult female averaging 72 to 80 bpm and 64 to 72 bpm in young adult males. It rises again in the elderly. Tachycardia is a persistent, resting adult heart rate above 100 bpm. In stress, anxiety, drugs, heart disease, or fever. In drop of stroke volume.

Heart Rate
Bradycardia is a persistent, resting adult heart rate below 60 bpm. during sleep, in endurance trained athletes. Endurance training enlarges the heart and increases its stroke volume. Thus, it can maintain the same cardiac output with fewer beats. Hypothermia (low body temperature). Diving mammals such as whales and seals exhibit bradycardia during the dive, as do humans to some extent when the face is immersed in cool water.