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Why the Heart Fails and How the Body Compensates

1Cardiac Output and the Determinants of Pump Performance2What Heart Failure Is and Why the Pump Fails3The Frank-Starling Response: Using Preload to Defend Output4Sympathetic Activation: Raising Rate and Contractility5The Renin-Angiotensin-Aldosterone System: Defending Volume and Pressure6Cardiac Remodeling: When Compensation Becomes the Disease
Cardiac Output and the Determinants of Pump Performance

Cardiac Output: Rate Times Volume

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Cardiac output is the volume of blood the heart pumps each minute, and it is simply heart rate multiplied by stroke volume. A resting adult typically has a heart rate near seventy beats per minute and a stroke volume near seventy milliliters, which gives about five liters per minute. The example on this page shows why the product matters: an athlete and a patient with a weak ventricle can both reach five liters per minute, but the patient does it with a small stroke volume and a very fast heart rate. That patient is relying on heart rate to defend output, and that reserve is limited.
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The cardiac output equation

\[CO = HR \times SV\] \(CO\) = cardiac output (L/min); \(HR\) = heart rate (beats/min); \(SV\) = stroke volume (mL/beat). At rest, \(CO \approx 5\ \text{L/min}\).

Why the product matters

Heart rate and stroke volume are controlled by different mechanisms, so they can move independently. A heart that cannot eject a normal volume per beat can still maintain output for a while by beating faster. The equation also shows the ceiling: if stroke volume is halved, heart rate must double to keep output constant, and heart rate cannot rise indefinitely.

Two routes to the same output

A trained endurance athlete may have a resting heart rate of 50 beats/min and a stroke volume of 100 mL, giving \(50 \times 100 = 5000\ \text{mL/min}\), or 5 L/min. A person with a weakened ventricle might have a stroke volume of only 35 mL and a heart rate of 140 beats/min, giving \(140 \times 35 = 4900\ \text{mL/min}\), also about 5 L/min. The output is nearly identical, but the second person is working near the limit of what heart rate can compensate for.

Normal range

Cardiac output at rest is usually quoted as 4–8 L/min and scales with body size, so it is often expressed as the cardiac index: cardiac output divided by body surface area, normally about 2.5–4.0 L/min/m².

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