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Cardiac Function (Cardiac Output and Its Determinants)

  • Loek P. B. Meijs
  • Alexander J. G. H. Bindels
  • Jan Bakker
  • Michael R. Pinsky
Chapter

Abstract

The cardiovascular system is designed to supply the body to the needs of metabolic demand. When cardiac output (CO) falls short or systemic metabolic demand is increased, the patient is in jeopardy. CO is greatly determined by the amount of venous return (VR) delivered to the right ventricle (RV). VR is dependent on the balance between unstressed and stressed volume, which portends the driving pressure for VR. Stressed volume can be calculated by measurement of mean systemic filling pressure (Pms). There are multiple (clinical and experimental) modalities to measure Pms. The net driving pressure estimated as the upstream pressure (Pms) relative to right atrial pressure (Pra), often deferred the driving pressure for venous return (Pvr). Resistance to flow, which counts for both arterial vascular resistance and resistance to venous return (RVR), is calculated by various methods depending on the vascular circuit and flow characteristics each circuit creates. In conjunction to the systemic circulation, atria serve as a reservoir and conduit, where the right atrium particularly plays an important role in modulating venous return. Owing to this reservoir and conduit function, atrial contraction plays a lesser role in delivery of blood to the chambers. The ventricles, thanks to the Frank-Starling effect, increase contraction when supplied with this preload. A complex interplay of inotropy, lusitropy, and chronotropy comprising both systolic and diastolic function enable the heart to optimally transfer the blood it receives, thereby assisted by the concepts of ventricular interdependence, ventriculo-arterial coupling, the role of the pericardium, and coronary blood supply.

Keywords

Cardiac Function Contractility Systolic Diastolic Inotrope Chronotropy Lusitropy Right Left Atrium Ventricle Ventricular Venous return Mean systemic filling pressure Stressed volume Unstressed volume Venous return 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Loek P. B. Meijs
    • 1
    • 2
  • Alexander J. G. H. Bindels
    • 2
  • Jan Bakker
    • 3
    • 4
    • 5
    • 6
  • Michael R. Pinsky
    • 7
  1. 1.Department of CardiologyCatharina HospitalEindhovenThe Netherlands
  2. 2.Department of Intensive CareCatharina HospitalEindhovenThe Netherlands
  3. 3.Department of Intensive Care AdultsErasmus MC University Medical Center, Erasmus University RotterdamRotterdamNetherlands
  4. 4.Division of Pulmonary, Allergy, and Critical Care MedicineColumbia University Medical CenterNew YorkUSA
  5. 5.Department of Pulmonary and Critical CareNew York UniversityNew YorkUSA
  6. 6.Department of Intensive CarePontificia Universidad Católica de ChileSantiagoChile
  7. 7.Department of Critical Care MedicineUniversity of PittsburghPittsburghUSA

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