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Regulation of Cardiac Output

  • Branko Furst
Chapter

Abstract

Models are used to simplify a group of observable events into readily understandable concepts. Over the years, numerous models of circulation have been developed in an effort to elucidate fundamental hemodynamic principles. They attest to the ingenuity on the part of the investigators but also point to the complexity of the subject at hand. Because the heart is the organ which is thought to provide the total hydraulic energy to the blood, the idea of the heart as a pressure-generating pump is implicit in most commonly used models. Just how much of a role the heart plays in blood propulsion and the relative contribution of the peripheral circulation in the regulation of cardiac output is a matter of ongoing debate. Because of the multitude of factors which contribute to the regulation of cardiac output, the subject will be approached from the two commonly used perspectives: that of the heart and of the peripheral circulation. The left ventricular (LV) view purports that the heart is the sole source of blood propulsion and hence the principal controller of cardiac output. Guyton’s “venous return” (VR) model posits, on the contrary, that the peripheral circulation is the main determinant of cardiac output and the heart plays a secondary role. LV and VR views are reviewed and critiqued for their conceptual and methodological inconsistencies. Trends in the pharmacologic therapy of heart failure and the declining use of intra-aortic balloon pumps speak in favor of the peripheral circulation as the principal determinant of cardiac output.

Keywords

Circulation models Left ventricular model Guyton’s venous return model Cardiac output Weber’s circulation model Peripheral resistance Elastic recoil Mean circulatory pressure Ohm’s law Heart failure therapy Aortic balloon pump 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Branko Furst
    • 1
  1. 1.Professor of AnesthesiologyAlbany Medical CollegeAlbanyUSA

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