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The Cardiac Output

Cardiac output refers to the volume of blood which the left ventri­cle forces into the aorta per minute of time. It must be noted that this term refers to the output of the left ventricle only, and that the total output is twice as much. The reason that the output of the left ventri­cle, is considered so important that it is given this special name is that it supplies the entire body (except the lungs) with the blood. Another reason is that it does a much greater amount of work than does the right, and consequently is more likely to fail. The work that the ventri­cle does depends not only on the volume of blood but upon the pres­sure against which they must beat, and that pressure is about six times as great in the aorta as in pulmonary artery-about80 mmin the first and only about15 mmin the second.

Cardiac output is the product of two factors: heart rate (the num­ber of beats per minute) and stroke

volume (the volume expelled per beat).

over the sympathetics. Thus, in­hibition of the vagus centre speeds up to the heart. And inhibition of the sympathetic centre would slow down the heart. It seems that in the human most of the effect is achieved by inhibition of the vagal centre of the sympathetic region as well.

the left ventricle ejects per beat. Within limits, the stroke volume depends upon the "venous return". The normal heart is capable of a considerable degree of enlargement; after the venous return is increased - as it is in exercise - the chambers of the heart are able to supply the additional blood. The walls of right atrium and the great veins are thin and stretch readily, so that the heart rate is increased.

The increased venous return in exercise is brought about in the following manner: 1) when muscles

contract, they exert a "milking" ef­fect on the blood vessels which they contain. With each contraction, blood is squeezed out1 into the veins - it cannot be squeezed back into the arteries because the arterial pressure is so high - and with each relaxation the blood vessels of the muscle again fill up with blood; 2) in exercise, breathing becomes deeper. The heart lies within the thorax; when the thorax expands, blood is "sucked2 into" the heart.

The two factors, working together, cause the amount of venous blood returned to be greatly increased. First the right side of the heart, and within a few beats the left, are dilated and take bigger "bites" of blood. Thus the stroke volume is increased.