Cardiac Physiology Pump Function

Jim Pierce Bi 145a Lecture 12, 2009-10

Cardiac Pump
The Heart Pumps Blood
by contraction and relaxation Contraction is called systole Relaxation is called diastole The Cardiac Cycle is the cycle through one systole and one diastole

Cardiac Pump
When the heart pumps, it generates:
Pressure Changes Volume Changes We talk about both
Blood Pressure, Arterial/Venous Pressure Cardiac Output, Venous Return

Cardiac Pump
We can measure pressures and volumes during the cardiac cycle

These will help us understand the heart

Echocardiography

Swan-Ganz Catheter

Swan-Ganz Catheter

Arterial Pressure

Swan-Ganz Catheter

Cardiopulmonary Function
When we combine cardiac output with oxygen carrying capacity of the blood, we begin to evaluate
Delivery of Oxygen

Swan-Ganz Parameters

Volumes
There are a variety of ways to measure vascular volumes. Volume per Time, or Flux
Thermodilution across compartments Oxygen Extraction across compartments

Absolute Volume
Echocardiogram (imaging study) Thermodilution in a compartment Actual Dilution (distribution across all compartments)

Pressure Versus Volume

Pressure and Volume are related Increasing Pressure will Increase Volume Decreasing Pressure will Decrease Volume Increasing Volume will Decrease Pressure Decreasing Volume will Increase Pressure

Compliance
Compliance is the change in pressure caused by a change in absolute volume Compliance = P / V Point Compliance = dP / dV

Compliance (Computation)

Compliance (Real)

Contractility

Contractility is the change in Volume per Time caused by a change in Pressure

Contractility = (dV/dT) / dP

Contractility

Compliance and Contractility

Contractility determines EMPTYING

Compliance determines FILLING

Pressure Volume Loop

Contractility

Area = Work

Compliance

Cardiac Cycle

Thus, each part of the cardiac cycle is dominated by a relationship between volume and pressure.

Cardiac Cycle
Systole
Muscle is Contracting A contracting sphere generates Pressure Pressure causes a change in Volume This is measured by CONTRACTILITY This is affected by
Function of Muscle Initial Volume (PRELOAD) Initial Pressure (AFTERLOAD)

Cardiac Cycle
Diastole
Muscle is Relaxing Veins return blood to the heart As the heart fills with blood, the absolute volume and pressure change This relationship is measured by COMPLIANCE This is affected by
Connective Tissue Venous Pressure Venous Resistance

Cardiac Cycle

Both systole and diastole can be divided into early and late phase

Cardiac Cycle
We begin at the end of diastole
Here, the ventricles are relaxed and maximally filled with blood, including an extra fuel injection fuel injection from the atria

Cardiac Cycle
Early Systole
The Pressure in the Ventricle is the same as in the great veins The Ventricle contracts The AV valves close Since the Aortic and Pulmonic valves were already closed, the heart is a closed ball As the heart contracts, the pressure in the ball rises at a fixed volume.

Cardiac Cycle
Early Systole
Is ISOMETRIC CONTRACTION!

Pressure Volume Loop

Early Systole

Cardiac Cycle
Late Systole
The Pressure in the Ventricles is the same as in the great arteries The A/P valves open Further contraction of the ventricles causes blood flow at a relatively constant pressure

(this is because the aorta is compliant as well and increase in volume causes only a small increase in pressure)

Cardiac Cycle
Late Systole

Is

ISOTONIC CONTRACTION!

Pressure Volume Loop

Late Systole

Cardiac Cycle
Early Diastole
The Ventricles begin to relax As the Ventricular pressure falls below the great artery pressure, the A/P valves close Since the AV valves were already closed, the heart is a closed ball As the heart relaxes, the pressure in the ball falls at a fixed volume. ISOMETRIC RELAXATION

Pressure Volume Loop

Early Diastole

Cardiac Cycle
Late Diastole
When the pressure inside the heart falls below the pressure of the great veins AND the papillary muscles have relaxed, the AV valves open The blood flows down its pressure gradient and the ventricles fill passively at a fixed pressure (because the ventricle has compliance) ISTONIC RELAXATION

Pressure Volume Loop

Late Diastole

Cardiac Cycle
End Diastole
Is unique because the atria contract This leads to an increase in pressure in three places:
The great veins The atria The ventricles

Pressure Volume Loop

End Diastole

Cardiac Cycle
End Diastole
Atrial Contraction

Early Systole
Isometric Contraction

Late Systole
Isotonic Contraction

Early Diastole
Isometric Relaxation

Late Diastole
Isotonic Relaxation

End Diastole

Cardiac Cycle
Why does this work? The heart is like a sphere. The volume of the sphere is a function of the radius. The surface diameter / area is a function of the radius Thus the surface area can be expressed as a function of the volume. Since the muscle fiber length is a function of the surface area

Cardiac Cycle
The muscle fiber length is a function of the Cardiac Volume Just like with a muscle or with a sphincter, we can draw a VOLUMEFORCE graph and a VOLUMESHORTENING graph (for isometric and isotonic contraction respectively)

Cardiac Cycle
Similarly, PRESSURE and VOLUME are related. So we can draw a PRESSUREFORCE and PRESSURESHORTENING graph, as well.

Cardiac Cycle
Thus, if we know two things:
Ventricular COMPLIANCE
(during diastole)

Ventricular CONTRACTILITY
(during systole)

We can use PRESSURE and VOLUME interchangably. (very useful!)

Cardiac Cycle
We discover that:
1) Initial Volume is PRELOAD
Also called END DIASTOLIC VOLUME Is related to END DIASTOLIC PRESSURE

2) AFTERLOAD is the outflow pressure

Also called BLOOD PRESSURE If we know the compliance and resistance (V=IR), then can be related to CARDIAC OUTPUT (Volume per time)

Pressure Volume Loop

Cardiac Pump
So now we ask:
1) What determines PRELOAD? 2) What determines AFTERLOAD? 3) How does the heart turn PRELOAD into CARDIAC OUTPUT against an AFTERLOAD?

Cardiac Output
First:
Systemic venous return must equal right cardiac output Right cardiac output must equal pulmonary venous return Pulmonary venous return must equal left cardiac output Left cardiac output must equal systemic venous return

Cardiac Output

Thus COright = COleft Flux is constant, even though pressure is not.

Cardiac Output
Second:
Blood comes in from Venous Return Despite lots of flow, there is little change in pressure Thus, the Venous return is from a capacitant system and provides preload to the heart

Cardiac Output
Third:
Blood goes into the Arterial Tree With the same amount of flow, there are much higher pressures Thus, the Arterial Tree is a resistance system, and that resistance is the afterload on the heart.

Cardiac Output
Is any vessel just a capacitor or resistor?

Of course not.

Cardiac Output
Capacitant Veins have venous resistance to control flow rates
(just like V=IR, P = JR, so J = P / R)

Resistant Arteries have capacitance

This capacitance allows them to dilate slightly to receive more volume at a given pressure, and is appropriately called compliance. (V / P)

Beginning Diastole

End Diastole

Beginning Systole

End Systole

Ventricular Pressure

Central Venous Pulse

Cardiac Output

Guytons Model

Venous Return

Venous Return

Venous Resistance

Frank - Starling Curve

Contractility

Cardiac Output

Blood Flux (CO versus VR)

Pressure versus Afterload

Velocity versus Afterload

Ventricular Pressure

Blood Flux (CO versus VR)

Cardiac Cycle

Economic Effects

Questions?