Intensive Care Medicine

, Volume 40, Issue 10, pp 1564–1566 | Cite as

Understanding venous return

  • David A. BerlinEmail author
  • Jan Bakker
Understanding the Disease

Cardiac output can increase fivefold to adapt to changing metabolic needs. Since normal contraction empties the heart of nearly all its blood, simply increasing the force or rate of contraction cannot explain the dramatic increase in cardiac output. Instead, the circulation mobilizes a large volume of blood from the compliant veins. The venous system stores two-thirds of the blood volume and serve as an adjustable reservoir [1, 2]. The Starling law explains that cardiac output is intrinsically coupled to the rate of blood return to the heart [1]. To increase cardiac output, the circulation increases venous return—the rate of blood flowing from the systemic veins into the right atrium. This review will discuss the mechanisms that regulate venous return.

A pressure gradient drives blood from the veins into the heart. The normal right atrial pressure at rest is 0 mmHg [1, 3, 4, 5]. Contraction empties the heart and maintains this normal (low) right atrial pressure. The mean systemic...


Cardiac Output Venous Return Atrial Pressure Cardiac Tamponade Ventricular Afterload 
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Conflicts of interest

The authors declare they have no financial conflict of interest.

Ethical standard

There were no human or animal subjects used for this study and there is no requirement for institutional review approval.


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of Intensive Care AdultsErasmus MC UniversityRotterdamThe Netherlands

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