CARDIAC OUT PUT,

VENOUS RETURN, and

THEIR REGULATION
M. Rasjad Indra
 Introduction
Cardiac output:
– The quantity of blood pumped into the aorta each
minute by heart
Venous return:
– The quantity of blood flowing from the veins into the
right atrium each minute
The venous return & the cardiac output must be
equal
– Except for a few heartbeats at a time when blood
might be temporarily being stored in or removed from
the heart and lung
 The factors directly affect cardiac output:
– The level of body metabolism
– Physical exercise
– Age
– Body size Cardiac index (3 L/minute/m2)
4

1
Age in years
c ai dr a C

0 10 20 30 40 50 60 70 80
Control of cardiac output by venous return
Heart pump automatically whatever amount of
blood flows into the right atrium from the veins
(Frank-Starling law of the heart).
Stretching of the sinus  increase heart rate
Strechting atrium  increase heart rate &
cardiac contractility (Bainbridge reflex).
The cardiac output is controlled almost entirely
by peripheral factors that determine the venous
return
CO~ The sum of blood flow regulation
in all the local tissues of the body
Factors that control local blood flow  Sum
of blood flow regulation  Venous return
 The heart pumps this returning blood
(cardiac output).
The reciprocal relationship between total
peripheral resistance & cardiac output.

MAP
CO =
R
 Cardiac Output Curve
Factors can make the heart hyper-effective:
1. Nervous stimulation
2. Hypertrophy of the heart muscle
 Factors that cause a hypo-effective heart:
 Any factors that decrease the heart ability:
1. Congenital heart disease
2. Myocarditis
3. Cardiac ischemia etc.
 Venous Return Curve

Right Atrial Pressure

Mean Systemic Filling Pressure
– The pressure measured every where in the
systemic circulation when all flow of blood is
stopped).
Resistance of blood flow
 Venous Return Curve

10

5
/ L( nr ut e R s uone V

Psf=14
Psf=3.5 Psf=7
0
-4 0 +4 +8 +12

Right Atrial Pressure (mm Hg)

m
Mean Circulatory & Mean Systemic
Filling Pressure
Blood volume ~ Mean Circulatory
Pressure
Sympathetic stimulation ~ Mean
Circulatory Pressure
Psf ~ Pcf because The pulmonary
circulation:
– Capacitance = 1/8 x Systemic
– Blood Volume = 1/10 x Systemic
Psf normal = 7 mmHg
Effect Psf. on Venous Return
The greater the mean filling pressure  The
more the venous return curve shifts upward and
to the right
The lower the mean systemic filling pressure 
The more the curve shifts downward and to the
left
VR = Venous Return
Psf − PRA
VR = Psf
PRA
= Mean Systemic Filling Pressure
= Right Atrial Pressure
RVR RVR = Venous Return Resistance
 Analysis of Cardiac Output & Right Atrial Pressure
Using simultaneous Cardiac Output Curve & Venous
Return Curve.

15
Normal resistance
2 x Resistance
½ resistance
1/3 resistance
10

5
nr ut e R s uone V

Psf=2.3 Psf=10
Psf=7
0
-4 0 +4 +8 +12

Right Atrial Pressure (mm Hg)

Method for Measuring Cardiac Output
1. Oxygen Fick Method:
Cardiac Out put (L/minute)=
O2 absorbed per minute by the lungs (ml/min)
Aterio venous O2 difference (ml/L) of blood

2. Indicator Dilution Method: