Tom Week 2

Learning Objectives – Blood on the Road

CARDIAC CYCLE AND CARDIAC OUTPUT

Objectives 1, 2, & 3: see attached pdf for sketches of pressure changes,

valve events, systole and diastole etc.

Objective 4: Define cardiac output and the relationship to stroke volume and
heart rate.

CO = volume of blood ejected from the left ventricle (or right ventricle) into the
aorta (or pulmonary trunk) each minute.

CO = Stroke volume x Heart rate, where

SV = volume of blood ejected by the ventricle each contraction

HR = number of contractions per minute

Mean Arterial Pressure (MAP) = [systolic + (2 x diastolic)] / 3

MAP is a measurement of the pressure gradient across the arterial system

CO = MAP / TPR, where

TPR (Total Peripheral Resistance) = sum of resistance provided by the

vessels of the systemic circulation

Objective 5: Sketch a graph of, and explain, the relationship between cardiac
filling and cardiac output (Frank-Starling Principle).

(See attached pdf for sketch)

The Frank-Starling principle states that stroke volume increases with diastolic
volume. The relationship is based on the principle that the force exerted by
the myocardial fibres during contraction is directly proportional to their length
or degree of stretch at the start of contraction (or end-diastolic volume). The
greater the end-diastolic volume, the more forceful the next contraction.

The Frank-Starling principle equalises the output of the right and left ventricle
and keeps the same volume of blood flowing to both the systemic and
pulmonary circulations.

Objective 6: List and explain the four determinants of cardiac output.

1…Stroke volume: (definition above)

2…Preload: the degree of stretch/distension of the heart before it contracts
3…Contractility: forcefulness of contraction of ventricular muscle fibres
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4….Afterload: the pressure that must be exceeded before ejection of blood

from the ventricles can occur i.e. the aortic and pulmonary trunk pressures.

NB: preload and contractility can be classed as components of one variable,

namely heart rate. As per the equation above (CO = SV x HR), we can
simplify the determinants of cardiac output as SV, HR and afterload.

The nervous system also has an effect on CO. Increase in sympathetic

stimulation leads to an increase in the rate of firing of the sinoatrial (SA) node
located in the atria.

In addition, if the SA node (located in a section of the atrial wall) experiences

distension from the increased filling volume, this will trigger an increase in
heart rate. Similarly, if the entire atrial chamber detects distension, this will
initiate the Bainbridge reflex leading to increased heart rate.

Objective 7: Describe the effect of altered inotropic state on the Frank-

Starling graph.

(See attached pdf for graph)

Inotrope: an agent that strengthens (positive inotrope) or weakens (negative

inotrope) the force of muscle contractions, particularly those of the heart.

Positive inotropic factors: sympathetic stimulation, adrenaline, noradrenaline,

thyroxine, glucagon

Negative inotropic factors: parasympathetic stimulation

NB: When preload is fixed, inotropic factors can either increase or decrease
the force of contraction (contractility).

UNIVERSAL PRECAUTIONS

Objective 1: Introduce and practice universal safety precautions in the clinical

environment.

Treat all blood and bodily fluids as if they are infected. Practising universal
precautions involves using personal protective equipment (PPE), proper
cleaning and decontamination methods, appropriate disposal of wastes and
filing an incident report to the hospital administration. These measures will
reduce the potential for infection of staff and patients alike.

Objective 2: Practice hand washing and aseptic technique.

Hand washing is a proven measure to reduce the transmission and

occurrence of infection. Use of alcohol-based liquids or antiseptic hand
washing lotions such as iodine or chlorhexidine are advised. Aseptic
technique involves practices and procedures that avoid/eliminate the
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possibility of contamination with microbial matter, for example, dressing a

wound, inserting a catheter, giving an injection. Health professionals should
follow procedure-specific protocols to maintain aseptic technique when
performing a sterile procedure.

REFERENCES

Lecture Notes (SOMS, Notre Dame Australia)

Tortora & Derrickson (2009) Principles of Anatomy and Physiology