By David G. Nichols, Duke E. Cameron
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Extra resources for Critical Heart Disease in Infants and Children, 2nd Edition
Venous Return Normally, the heart passively pumps all of the venous return it receives. It has tremendous preload reserve and can increase cardiac output threefold with increasing venous return. Under most conditions, it is venous return that determines cardiac output. Considering that venous return determines cardiac output, understanding what regulates venous return becomes the key to understanding what regulates cardiac output. Venous return is determined by the sum of the venous return from each organ.
At point B diastole ends (mitral valve closes) prior to ventricular contraction. Point C is the end of isovolumic contraction when the aortic valve opens prior to ejection. Point D is the end of ventricular ejection (systole) when the aortic valve closes before isovolumic relaxation. Line A-B thus represents ventricular filling during diastole. Line B-C represents the period of isovolumic contraction with rising ventricular pressure and no change in ventricular volume. Line C-D represents ventricular ejection.
3. Ventricular outflow tract obstruction can increase the load against which the heart must work. Thus valvular stenosis significantly affects ventricular afterload. 4. Ventricular wall stress is also a major determinant of afterload. Laplace’s law simply states that the circumferential wall stress (T) is equal to the pressure (P) times the radius (r) divided by twice the wall thickness (t): T = (P × r) / 2t In the heart, which is exposed to pressure from the outside (pericardial or intrathoracic pressure) and the inside (intraluminal pressure), the pressure that is important is the transmural pressure or LVtm = LV intraluminal − LV extraluminal (or pericardial) Although this is a simplification, several points are important to note.