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Cardiac Function (Cardiac Output and Its Determinants)

  • Loek P. B. MeijsEmail author
  • Alexander J. G. H. Bindels
  • Jan Bakker
  • Michael R. Pinsky
Chapter
First Online:

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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References

  1. 1.
    Katz AM, Rolett EL. Heart failure: when form fails to follow function. Eur Heart J. 2016;37:449–54.CrossRefGoogle Scholar
  2. 2.
    Funk DJ, Jacobsohn E, Kumar A. The role of venous return in critical illness and shock–part I: physiology. Crit Care Med. 2013;41:255–62.CrossRefPubMedGoogle Scholar
  3. 3.
    Gelman S. Venous function and central venous pressure—a physiologic story. Anesthesiology. 2008;108:735–48.CrossRefPubMedGoogle Scholar
  4. 4.
    Bressack MA, Raffin TA. Importance of venous return, venous resistance and mean circulatory pressure in the physiology and management of shock. Chest. 1987;92:906–12.CrossRefPubMedGoogle Scholar
  5. 5.
    Anderson RM, Fritz JM, O’Hare JE. The mechanical nature of the heart as a pump. Am Heart J. 1967;73(1):92–105.CrossRefPubMedGoogle Scholar
  6. 6.
    Anderson RM. The gross physiology of the cardiovascular system. Tucson, AZ: Racquet Press; 1993.Google Scholar
  7. 7.
    Guyton AC, Abernathy B, Langston JB, Kaufmann BN, Fairchild HM. Relative importance of venous and arterial resistances in controlling venous return and cardiac output. Am J Physiol. 1954;179(2):261–7.PubMedGoogle Scholar
  8. 8.
    Guyton AC, Polizo D, Armstrong GG. Mean circulatory filling pressure measured immediately after cessation of heart pumping. Am J Physiol. 1959;196(5):1008–14.PubMedGoogle Scholar
  9. 9.
    Guyton AC, Lindsey AW, Kaufmann BN. Effect of mean circulatory filling pressure and other peripheral circulatory factors on cardiac output. Am J Physiol. 1955;180(3):463–8.PubMedGoogle Scholar
  10. 10.
    Guyton AC, Lindsey AW, Abernathy B, Richardson T. Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol. 1957;189(3):609–15.PubMedGoogle Scholar
  11. 11.
    Beard DA, Feigl EO. Understanding Guyton’s venous return curves. Am J Physiol Heart Circ Physiol. 2011;301:629–33.CrossRefGoogle Scholar
  12. 12.
    Grodins FS, Stuart WH, Veenstra RL. Performance characteristics of the right heart bypass preparation. Am J Physiol. 1960;198:552–60.PubMedGoogle Scholar
  13. 13.
    Starling EH. The Linacre Lecture on the Law of the Heart. London: Longmans, Green & Company; 1918.Google Scholar
  14. 14.
    Rothe CF. Mean circulatory filling pressure: its meaning and measurement. J Appl Physiol. 1993;74:499–509.CrossRefPubMedGoogle Scholar
  15. 15.
    Pinsky MR. Mean systemic pressure monitoring. In: Cannesson M, Pearse R, editors. Perioperative hemodynamic monitoring and goal directed therapy. Cambridge: Cambridge University Press; 2014. p. 157–62.CrossRefGoogle Scholar
  16. 16.
    Pinsky MR. Instantaneous venous return curves in an intact canine preparation. J Appl Physiol. 1984;56:765–71.CrossRefPubMedGoogle Scholar
  17. 17.
    Versprille A, Jansen JR. Mean systemic filling pressure as a characteristic for venous return. Pflugers Arch. 1985;405:226–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Maas JJ, Pinsky MR, Geerts BF, de Wilde RB, Jansen JR. Estimation of mean systemic filling pressure in postoperative cardiac surgery patients with three methods. Intensive Care Med. 2012;38:1452–60.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Maas JJ, Geert BF, Van den Berg PC, Pinsky MR, Jansen JRC. Assessment of venous return curve and mean systemic filling pressure in postoperative cardiac surgery patients. Crit Care Med. 2009;37:912–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Schipke JD, Heusch G, Sanii AP, Gams E, Winter J. Static filling pressure in patients during induced ventricular fibrillation. Am J Physiol Heart Circ Physiol. 2003;285:2510–5.CrossRefGoogle Scholar
  21. 21.
    Repessé X, Charron C, Fink J, Beauchet A, Deleu F, Slama M, Belliard G, Vieillard-Baron A. Value and determinants of the mean systemic filling pressure in critically ill patients. Am J Physiol Heart Circ Physiol. 2015;309:1003–7.CrossRefGoogle Scholar
  22. 22.
    Parkin WG, Wright CA. Three dimensional closed loop control of the human circulation. J Clin Monit Comput. 1991;8:35–42.CrossRefGoogle Scholar
  23. 23.
    Parkin WG, Wright CA, Bellomo R, Boyce N. Use of a mean systemic filling pressure analogue during the closed-loop control of fluid replacement in continuous hemodiafiltration. J Crit Care. 1994;9:124–33.CrossRefPubMedGoogle Scholar
  24. 24.
    Parkin WG. Volume state control—a new approach. Crit Care Resusc. 1999;1:311–21.PubMedGoogle Scholar
  25. 25.
    Parkin WG, Leaning MS. Therapeutic control of the circulation. J Clin Monit Comput. 2008;22:391–400.CrossRefPubMedGoogle Scholar
  26. 26.
    Pellegrino VA, Mudaliar Y, Gopalakrishnan M, Hortons MD, Killick CJ, Parkin WG, Playford HR, Raper RF. Computer based haemodynamic guidance system is effective and safe in management of postoperative cardiac surgery patients. Anaesth Intensive Care. 2011;39:191–201.PubMedGoogle Scholar
  27. 27.
    Cecconi M, Hollmann DA, Geisen M, Ebm C, Fletcher N, Grounds RM, Rhodes A. Changes in the mean systemic filling pressure during a fluid challenge in postsurgical intensive care patients. Intensive Care Med. 2013;39:1299–305.CrossRefPubMedGoogle Scholar
  28. 28.
    Opie LH, Bers DM. Mechanisms of cardiac contraction and relaxation. In: Libby P, Bonow RO, Mann DL, Zipes DP, editors. Heart disease: a textbook of cardiovascular medicine. 10th ed. Philadelphia: WB Saunders; 2015. p. 429–53.Google Scholar
  29. 29.
    Pagel PS, Kehl F, Gare M, et al. Mechanical function of the left atrium: new insights based on analysis of pressure-volume relations and Doppler echocardiography. Anesthesiology. 2003;98:975.CrossRefPubMedGoogle Scholar
  30. 30.
    Mitchell JH, Gilmore JP, Sarnoff SJ. The transport function of the atrium. Factors influencing the relation between mean left atrial pressure and left ventricular end-diastolic pressure. Am J Cardiol. 1962;9:237.CrossRefPubMedGoogle Scholar
  31. 31.
    Mitchell JH, Gupta DN, Payne RM. Influence of atrial systole on effective ventricular stroke volume. Circ Res. 1965;17:11.CrossRefPubMedGoogle Scholar
  32. 32.
    Grandi E, Pandit SV, Voigt N, et al. Human atrial action potential and Ca2+ model: Sinus rhythm and chronic atrial fibrillation. Circ Res. 2011;109:1055.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Von Anrep G. On the part played by the suprarenals in the normal vascular reactions of the body. Am J Physiol. 1912;45:307–17.CrossRefGoogle Scholar
  34. 34.
    Haddad, et al. Right ventricular function in cardiovascular disease, part I. Anatomy, physiology, aging and functional assessment of the right ventricle. Circulation. 2008;117:1436–48.CrossRefPubMedGoogle Scholar
  35. 35.
    Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart. 2006;92(Suppl 1):i2–i13.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Starr I, Jeffers WA, Meade RH. The absence of conspicuous increments of venous pressure after severe damage to the right ventricle of the dog, with a discussion of the relation between clinical congestive failure and heart disease. Am Heart J. 1943;26:291–301.CrossRefGoogle Scholar
  37. 37.
    Guyton AC, Lindsey AW, Gilluly JJ. The limits of right ventricular compensation following acute increase in pulmonary circulatory resistance. Circ Res. 1954;4:326–32.CrossRefGoogle Scholar
  38. 38.
    Suga H, Sugawa K. Instantaneous pressure–volume relationships and their ratio in the excised supported canine left ventricle. Circ Res. 1974;35:117.CrossRefPubMedGoogle Scholar
  39. 39.
    Pinsky MR. Circulation and circulatory support in the critically ill. In: Warrell DA, Cox TM, Firth JD, editors. Oxford textbook of medicine. 5th ed. Oxford: Oxford University Press; 2015.Google Scholar
  40. 40.
    Little WC. Diastolic dysfunction beyond distensibility: adverse effects of ventricular dilatation. Circulation. 2005;112:2888.PubMedGoogle Scholar
  41. 41.
    Rain S, Handoko ML, Trip P, Gan CT, Westerhof N, Stienen GJ, Paulus WJ, Ottenheijm CA, Marcus JT, Dorfmüller P, Guignabert C, Humbert M, Macdonald P, Dos Remedios C, Postmus PE, Saripalli C, Hidalgo CG, Granzier HL, Vonk-Noordegraaf A, van der Velden J, de Man FS. Right ventricular diastolic impairment in patients with pulmonary arterial hypertension. Circulation. 2013;128:2016–25.CrossRefPubMedGoogle Scholar
  42. 42.
    Damiano RJ Jr, La Follette P Jr, Cox JL, Lowe JE, Santamore WP. Significant left ventricular contribution to right ventricular systolic function. Am J Physiol. 1991;261:H1514–24.PubMedGoogle Scholar
  43. 43.
    Barthélémy R, Gayat E, Mebazaa A. Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheter). In: Tubaro M, Vranckxx P, Price S, Vrints C, editors. The ESC textbook of intensive and acute cardiovascular care. 2nd ed. Oxford: Oxford University Press; 2015. p. 101–10.Google Scholar
  44. 44.
    Guarracino F, Baldassarri R, Pinsky MR. Ventriculo-arterial decoupling in acutely altered hemodynamic states. In: Vincent JL, editor. Yearbook of intensive care and emergency medicine. Heidelberg: Springer; 2013. p. 225–36.Google Scholar
  45. 45.
    Feigl EO. Coronary physiology. Physiol Rev. 1983;63:1.CrossRefPubMedGoogle Scholar
  46. 46.
    Johnson D. The pericardium. In: Standring S, et al., editors. Gray’s anatomy. New York: Elsevier Churchill Livingstone; 2005. p. 995–6.Google Scholar
  47. 47.
    Jöbsis PD, Ashikaga H, Wen H, et al. The visceral pericardium: macromolecular structure and contribution to passive mechanical properties of the left ventricle. Am J Physiol. 2007;293:H3379.Google Scholar
  48. 48.
    Eeffe O’Rourke RA, Dell’Italia LJ. Diagnosis and management of right ventricular myocardial infarction. Curr Probl Cardiol. 2004;29:6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Loek P. B. Meijs
    • 1
    • 2
    Email author
  • 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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