Monitoring Tissue Perfusion in Shock pp 51-76 | Cite as
Cardiac Function (Cardiac Output and Its Determinants)
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 returnReferences
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