Cardiac Input - Clinical Uses

Clinical Uses

The function of the heart is to transport blood to deliver oxygen, nutrients and chemicals to the cells of the body to ensure their survival and proper function and to remove the cellular wastes. Since the heart is a 'demand pump', that pumps out whatever blood comes back into it from the venous system, it is effectively the amount of blood returning to the heart that determines how much blood the heart pumps out (Q). This, in turn, is controlled principally by the demand for oxygen by the cells of the body and the capacitance of the arterio-venous system. If the body has a high metabolic oxygen demand then the metabolically-controlled flow through the tissues is increased, leading to a greater flow of blood back to the heart. This is also modified by the function of the vessels of the body as they actively relax and contract thereby increasing and decreasing the resistance to flow.

When Q increases in a healthy but untrained individual, most of the increase can be attributed to an increase in heart rate (HR). Change of posture, increased sympathetic nervous system activity, and decreased parasympathetic nervous system activity can also increase cardiac output. HR can vary by a factor of approximately 3, between 60 and 180 beats per minute, while stroke volume (SV) can vary between 70 and 120 ml, a factor of only 1.7.

A parameter related to SV is Ejection Fraction (EF). EF is the fraction of blood ejected by the Left Ventricle (LV) during the contraction or ejection phase of the cardiac cycle or Systole. Prior to the start of Systole, the LV is filled with blood to the capacity known as End Diastolic Volume (EDV) during the filling phase or diastole. During Systole, the LV contracts and ejects blood until it reaches its minimum capacity known as End Systolic Volume (ESV), it does not empty completely. Clearly the EF is dependent on the ventricular EDV which may vary with ventricular disease associated with ventricular dilatation. Even with LV dilatation and impaired contraction the Q may remain constant due to an increase in EDV.

Stroke Volume (SV) = EDV – ESV
Ejection Fraction (EF) = (SV / EDV) × 100%
Cardiac Output (Q) = SV × HR
Cardiac Index (CI) = Q / Body Surface Area (BSA) = SV × HR/BSA
HR is Heart Rate, expressed as BPM (Beats Per Minute)
BSA is Body Surface Area in square metres.

Diseases of the cardiovascular system are often associated with changes in Q, particularly the pandemic diseases of hypertension and heart failure. Cardiovascular disease can be associated with increased Q as occurs during infection and sepsis, or decreased Q, as in cardiomyopathy and heart failure. The ability to accurately measure Q is important in clinical medicine as it provides for improved diagnosis of abnormalities, and can be used to guide appropriate management. Q measurement, if it were accurate and non-invasive, would be adopted as part of every clinical examination from general observations to the intensive care ward, and would be as common as simple blood pressure measurements are now. Such practice, if it were adopted, may revolutionise the treatment of many cardiovascular diseases including hypertension and heart failure. This is the reason why Q measurement is now an important research and clinical focus in cardiovascular medicine.

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