Evaluation of pumping

function of heart

 Stroke volume
Cardiac output
Ejection Fraction
Cardiac index
 Stroke volume

Stroke volume (SV) is the volume pumped

out by the heart with each beat.

 SV for an average person at rest is 70ml

 Cardiac output

Cardiac output is the quantity of blood

pumped into the aorta each minute by the heart.

This is also the quantity of blood that flows

through the circulation and is responsible for

tranporting substances to and from the tissues.

 Cardiac output (CO) is the product of
heart rate (HR) and stroke volume (SV):

CO = HR x SV

For a 70kg man normal values are

HR=70/min and SV=70ml, giving a cardiac
output of about 5litre/min. The cardiac index is
the cardiac output per square metre of body
surface area - normal values range from 2.5-4.0
litre/min/m2.
 Cardiac output varies widely with the level

of activity of the body, such as age, size of

the body, exercising and so on.

For young, healthy men, resting cardiac

output averages about 5.6L/min. For woman,

this value is 10 to 20 per cent less.

 Ejection Fraction

 Ejection fraction is the fraction of EDV that

ejected in one stroke.

SV
EF = 100 %
EDV
 Normal value: ~ 55%
 For a healthy heart, ejection fraction is relative
constant as SV is always proportional to EDV.
 Cardiac index

Because the cardiac output changes

markedly with body size, it has been important
to find some means by which the cardiac output
of different sized people can be compared with
one another. Experiments have shown that the
cardiac output increases approximately in
proportion to the surface area of the body.
 Therefore ,cardiac output is frequently
stated in terms of the cardiac index, which is
the cardiac output per square meter of body
surface area. The normal human being weighing
70 kilograms has a body surface area of about
1.7 square meters, which means that the
normal average cardiac index for adults is
about 3L/min/m2 of body surface area.
4) Heart sounds

The first heart sound

The second heart sound
The heart sounds are mainly

associated with the closure of the

valves.
 The first heart sound

Definition: The first heart sound is mainly

caused by the closure of A-V and tricuspid
valves at the start of ventricular systole.

Significance: it indicates the beginning of

ventricular systole.

Characters: low-pitch and long duration .

 The second heart sound

Definition: The second heart sound is mainly

caused by the closure of aortic and pulmonary
valves just after the end of ventricular systole.

Significance: it indicates the beginning of

ventricular diastole.

Characters: high -pitch and short duration.

 When listening to a patient’s heart, the
cadence of the beat will usually distinguish S1
from S2. Because diastole takes about twice as
long as systole, there is a longer pause between
S2 and S1 than there is between S1 and S2.
However, rapid heart rates can shorten
diastole to the point where it is difficult to
discern which is S1 and which is S2 .
Auscultation
 Auscultation is an essential part of even a

cursory cardiac exam.  Listening to the heart

you can gather information about the  1) rate

and rhythm, 2) value functioning (e.g. stenosis,

regurgitation/insufficiency), and 3) anatomical

defects (e.g. atrial septal defects, ventricular

septal defect (VSD), hypertrophy).

stethoscope
stethoscope
Where to place your stethoscope?

As with palpation of the heart,

auscultation should proceed in a logical

manner over 4 general areas on the

anterior chest, beginning with the

patient in the supine position. 

 The 4 percordial areas are examined
with diaphragm, including:

Aortic region (between the 2nd and 3rd intercostal

spaces at the right sternal border).
Pulmonic region (between the 2nd and 3rd intercostal
spaces at the left sternal border).
Tricuspid region (between the 3rd, 4th, 5th, and 6th
intercostal spaces at the left sternal border).
Mitral region (near the apex of the heard between
the 5th and 6th intercostal spaces in the mid-
clavicular line).
S1 is loudest in S2 is loudest over
the mitral area the aortic area
auscultation
 Related diseases:

Heart valves don't always work as they should.

A person can be born with an abnormal heart valve,
a type of congenital heart defect. Also, a valve can
become damaged by

•infections such as infective endocarditis

•rheumatic fever
•changes in valve structure in the elderly
2. Cardiac muscle contractility

1) Preload: the load that is given to the

muscle prior to its contraction.

2) Afterload: the load that is given to the

muscle after the beginning of the
contraction.
 1) Effects of preload

Frank-starling law:

Energy of heart contraction is

proportional to the initial length of

cardiac muscle fiber.

The Frank-Starling
law means that the
greater the heart
muscle is stretched
during filling, the
greater the force of
contraction and the
greater the quantity
of blood pumped into
the aorta.
What is the explanation of the Frank-
Starling mechanism?

When an extra amount of blood flows

into the ventricles, the cardiac muscle
itself is stretched to greater length. The
ventricle, because of its increase pumping,
automatically pumps the extra blood into
the arteries.
 Under most conditions the amount of

blood pumped by the heart each minute is

determined almost entirely by the rate of

blood flow into the heart from the veins,

which is called venous return.

 That is, each peripheral tissue of the
body controls its own local blood flow, and the
total of all the local blood through all the
peripheral tissues flowing by way of the veins
to the right atrium. The heart in turn
automatically pumps this incoming blood into
the systemic arteries, so that it can flow
around the circuit again.

Therefore, preload is proportional

to the venous return.
 Importance of Heterometric
Autoregulation

1. It is responsible for the precise, beat-to-beat

balance between the outputs of the right and
left ventricles.
2. It thus insures that the total blood volume
remains distributed in the proper way between
the systemic circulation and pulmonary
circulation.
3. Without this precise balance, blood would pool in
the lungs causing pulmonary edema. 
Just remember: "What goes in must come out."
2) Effects of afterload

Afterload can be viewed

as the "load" that the
heart must eject blood
against
　 In simple terms, the
afterload is closely
related to the aortic
pressure.
Briefly, an increase in afterload decreases
the velocity of fiber shortening, resulting
a decrease in SV.
With the rising of blood pressure, the

afterloads become to increase, which make

the heart to beat with more energy and

more difficulty. That is to say, cardiac

output is inverse proportion to blood

pressure.
AP ↑ → Afterload↑→The ventricle will have

to generate increased pressure→ decreases

the velocity of cardiac fibers

shortening→The ejection velocity after the

valve opens will be reduced→less blood will

be ejected→SV↓

→ESV↑+venous return→EDV↑→Adjust

By Frank-Starling law.
 SUMMARY
 Preload of the ventricles is provided by
venous pressure (VP)
 Afterload is provided by arterial blood
pressure.
 SV (or SW) is proportional to the initial fiber
length ( Starling’s law).
 The mechanism underlying Starling’s law is
the degree of overlap of muscle filaments.
 Operation of Starling’s law matches CO
from both sides of the heart.
Cardiac Output
 Ask Yourself:
1. Were the ranking of your reclining,
sitting, standing, and active cardiac
output measurements the same as your
predictions? Explain.
2. What factors influence your cardiac
output?
3. Compare your resting and active cardiac
output. What is your cardiac reserve?
See background notes.
4. Compare your cardiac output measurements with four other
classmates . Are they the same-why or why not? Explain:
 
5. Compare the cardiac output measurements of males and
females. Can you make a statement based on your
observations about gender and cardiac output?
 
 
 6. Cardiac functions such as cardiac output are
regularly recorded for the astronauts during their
space flight. Is it important to have each
astronaut's "earth normal" or pre-flight
measurements? Why?