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Regulation of stroke volume & heart rate
• Measurement of cardiac output• Regulation of heart rate
– neural
• Regulation of stroke volume– Preload– Afterload– Neural
• Control of cardiac output
Measurement of cardiac output
• Fick indicator-dilution method– measures the time taken for an
injected dye to pass a sampling point
• Thermodilution• Echocardiography• Pulsed Doppler ultrasound
Regulation of heart rate
• Sympathetic nervous system– sympathetic nerves release norepinephrine– plus circulating epinephrine from adrenal medulla– both act on ß-receptors on sinoatrial node– increases slope of the pacemaker potential – increases heart rate = tachycardia
+25
0
-25
-50
-75
mV
Regulation of heart rate
• Parasympathetic nervous system– vagus releases ACh – acts on muscarinic receptors on sinoatrial node– hyperpolarises cells and decreases slope of pacemaker
potential– decreases heart rate = bradycardia
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0
-25
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Regulation of stroke volume - preload
Starlings Law states - the energy of contraction is proportional to the initial length of the cardiac muscle fibre
Length
Ten
sion
(= preload)
Regulation of stroke volume - preload
In vivo, preload is affected by the End Diastolic Volume
End Diastolic Volume
Str
oke
V
olu
me
Increased venous return, increases EDV, and therefore increases stroke volume = self-regulation
Resting EDV
Regulation of stroke volume - afterload
• Afterload is the load against which the muscle tries to contract
• In vivo, afterload is set by the arterial pressure against which the blood is expelled (this in turn depends on the Total Peripheral Resistance)
• If TPR increases, stroke volume will go down
Regulation of stroke volume - neural
• Sympathetic nervous system– sympathetic nerves releasing norepinephrine– plus circulating epinephrine from adrenal medulla
– both act on ß1-receptors on the myocytes
– increases contractility (an inotropic effect)– gives stronger, but shorter contraction
• Parasympathetic– little effect
End Diastolic Volume
Str
oke
V
olu
me + sympathetic stimulation
Control of cardiac output• HR increases
– via decrease vagal tone– & increased sympathetic tone
• Contractility increases– via increased sympathetic tone– alters inotropic state & shortens systole
• Venous return increases– via venoconstriction– & skeletal/respiratory pumps– maintains preload
• Total peripheral resistance falls– due to arteriolar dilation in muscle, skin & heart– reduces afterload
• CO increase 4-6 times
HR x SV = CO
Summary• Heart rate
– sympathetic supply HR– parasympathetic supply HR
• Stroke volume– preload EDV, SV– afterload TPR, SV– neural sympathetic supply, SV
• Think integration– these work together to produce a co-ordinated
increase in CO, eg exercise