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Negative inotropic agents include hypoxia, acidosis, hyperkalemia, and a variety of synthetic drugs. These include numerous beta blockers and calcium channel blockers. Early beta blocker drugs include propranolol and pronethalol, and are credited with revolutionizing treatment of cardiac patients experiencing angina pectoris. There is also a large class of dihydropyridine, phenylalkylamine, and benzothiazepine calcium channel blockers that may be administered decreasing the strength of contraction and SV.

Afterload

Afterload refers to the tension that the ventricles must develop to pump blood effectively against the resistance in the vascular system. Any condition that increases resistance requires a greater afterload to force open the semilunar valves and pump the blood. Damage to the valves, such as stenosis, which makes them harder to open will also increase afterload. Any decrease in resistance decreases the afterload. [link] summarizes the major factors influencing SV, [link] summarizes the major factors influencing CO, and [link] and [link] summarize cardiac responses to increased and decreased blood flow and pressure in order to restore homeostasis.

Major factors influencing stroke volume

This table describes major factors influencing stroke volume. Preload may be raised due to fast filling time or increased venous return. These factors increase end diastolic volume and increase stroke volume. Preload may be lowered due to decreased thyroid hormones, decreased calcium ions, high or low potassium ions, high or low sodium, low body temperature, hypoxia, abnormal pH balance, or drugs (for example, calcium channel blockers). These factors decrease end diastolic volume and decrease stroke volume. Contractility may be raised due to sympathetic stimulation, epinephrine and norepinephrine, high intracellular calcium ions, high blood calcium level, thyroid hormones, or glucagon. These factors decrease end systolic volume and increase stroke volume. Contractility may be lowered due to parasympathetic stimulation, acetylcholine, hypoxia, or hyperkalemia. These factors increase end systolic volume and decrease stroke volume. Afterload may be raised due to increased vascular resistance or semilunar valve damage. These factors increase end systolic volume and decrease stroke volume. Afterload may be lowered due to decreased vascular resistance. This factor decreases end systolic volume and increases stroke volume.
Multiple factors impact preload, afterload, and contractility, and are the major considerations influencing SV.

Summary of major factors influencing cardiac output

This flowchart lists all the important factors that affect cardiac output.
The primary factors influencing HR include autonomic innervation plus endocrine control. Not shown are environmental factors, such as electrolytes, metabolic products, and temperature. The primary factors controlling SV include preload, contractility, and afterload. Other factors such as electrolytes may be classified as either positive or negative inotropic agents.
Cardiac Response to Decreasing Blood Flow and Pressure Due to Decreasing Cardiac Output
Baroreceptors (aorta, carotid arteries, venae cavae, and atria) Chemoreceptors (both central nervous system and in proximity to baroreceptors)
Sensitive to Decreasing stretch Decreasing O 2 and increasing CO 2 , H + , and lactic acid
Target Parasympathetic stimulation suppressed Sympathetic stimulation increased
Response of heart Increasing heart rate and increasing stroke volume Increasing heart rate and increasing stroke volume
Overall effect Increasing blood flow and pressure due to increasing cardiac output; hemostasis restored Increasing blood flow and pressure due to increasing cardiac output; hemostasis restored
Cardiac Response to Increasing Blood Flow and Pressure Due to Increasing Cardiac Output
Baroreceptors (aorta, carotid arteries, venae cavae, and atria) Chemoreceptors (both central nervous system and in proximity to baroreceptors)
Sensitive to Increasing stretch Increasing O 2 and decreasing CO 2 , H + , and lactic acid
Target Parasympathetic stimulation increased Sympathetic stimulation suppressed
Response of heart Decreasing heart rate and decreasing stroke volume Decreasing heart rate and decreasing stroke volume
Overall effect Decreasing blood flow and pressure due to decreasing cardiac output; hemostasis restored Decreasing blood flow and pressure due to decreasing cardiac output; hemostasis restored

Chapter review

Many factors affect HR and SV, and together, they contribute to cardiac function. HR is largely determined and regulated by autonomic stimulation and hormones. There are several feedback loops that contribute to maintaining homeostasis dependent upon activity levels, such as the atrial reflex, which is determined by venous return.

SV is regulated by autonomic innervation and hormones, but also by filling time and venous return. Venous return is determined by activity of the skeletal muscles, blood volume, and changes in peripheral circulation. Venous return determines preload and the atrial reflex. Filling time directly related to HR also determines preload. Preload then impacts both EDV and ESV. Autonomic innervation and hormones largely regulate contractility. Contractility impacts EDV as does afterload. CO is the product of HR multiplied by SV. SV is the difference between EDV and ESV.

Questions & Answers

thank you sooo much bro
Fatima Reply
helloo
Sentamu
Fatima hw a u
Sentamu
hii
Shubham
any one elaborate fr me foramens of the skull and features which they transmit
Sentamu
icant undrestand plz
zahruuzh Reply
try to read I hop you will understand
state and explain 20 radiology uses
ILYAS Reply
what are chemicals in anatomy and physiology?
Mike Reply
what can I do to find it easy for me in anatomy and physiology course
Mike
study up on the basics of the periodic chart, learn bones and muscles attachments, and learn muscles. Those take the longest to memorize. After that it should be a little easier.
Toni
what are the two types of body cells
Jennifer Reply
what is malnutrition
Claire
malnutrition refers to faulty nutrition resulting from malabsorption,poor diet or overeating. Sometimes too these food do not contain all the six food nutrients in their right proportion.
Yakubu
thank you
Claire
welcome
Yakubu
Will u be malnourished?
Baigwa
gud
Budumari
What's the difference between radiology and radiology
gabriel
Nothing! Radiology it means the study or using of radiation in medical science it can be 1.diagnose or treatment diagnosed radiology! x- ray. ultrasound. ct-scan. mammogram. MRI. 2. treatmen- radiation oncology, like Cobalt 60. and nuclear medicine
Larry
what is X-ray?
Nissar
X-ray is type of light that make it possible to see inside any object. as human body
KUNDAN
How the nervous system develops
ayiesher Reply
From the cells at the back of an embryo
Mma
breifly explain anatomy of thorax
Hadiza Reply
How many region the rib is divided
Konneh
how many bon of human being
Nura
206
John
how to study for the skeletal system
ryaisha
and anatomy
ryaisha
I really need sources immediately
ryaisha
I printed out all the different bones. Put them in the see through protective sheaths and got dry erase markers. I could right on them and erase to help me learn to spell the names of markings and bones.
Toni
Or go to a book store, Barnes and Noble(doesn't have to be this) and they have coloring books for anatomy. $16. Really helpful.
Toni
okay thanks and are what study tools you use to study the materials and get a better understanding
ryaisha
*what are
ryaisha
hiii
Roopa
I prefer diagrams, pictures that lay out each step with the information in each step. For Example: how action potential creates muscles to move. A pictured diagram gives me a better understanding of how each piece plays a role in each step of the process.
Toni
Also for basics, such as memorizing vocab. Flash cards are great. Don't become discouraged if you don't get them all right the first times through. The more you go through them, your brain will remember pieces of information from each and help you to pull out the information 😉
Toni
okay thanks
ryaisha
what is the functions of the lips in human
Momboi Reply
could I say sensation?
Sovilace
kissing
Obrian
for protection
Omar
Lips assist in speech and eating
Cindy
Too many easy questions. Which bones are the axial and appendicular? What are the abbreviations for TEE, TTE, AED, A-Mode, B-Mode, and LTH? What is the difference between hypothalamus and thalamus? Where is the parathyroid located? How many True Ribs do we have?
Sovilace Reply
Transesophageal echocardiography Transthoracic Echocardiography automated external defibrillator brightnees mode Los Hermanos Taverna
Inam
what is anatomy
okello Reply
anatomy is scientific study of body structures and how they relate to each other
Skeater
Are there other functions of the nucleolus apart from synthesis of RNA and formation of ribosomes
Peninah Reply
plays a role in cell response to stress
airiz
what is angle of auscultation
Bryan Reply
Anatomy which is the study of the human body structure has a couple of reasons it is been studied It helps to discover genetic disease cytology And histology which is the study of tissues Physiology is the study of function of the human cells It helps to know how the different body part works Its helps to know how part of the brain works And lastly It gives the essential to understand more about anatomy
Stephen Reply
describe the external features of a spinal cord
okoche Reply
Spinal nerves emerge in pairs, one from each side of the spinal cord along its length. The cervical nerves form a plexus (a complex interwoven network of nerves—nerves converge and branch). The cervical enlargement is a widening in the upper part of the spinal cord (C 4–T 1). Nerves that extend in
Inam
Hormones regulate certain target cell responses. These can include which of the following?
Nazareth Reply
describe the external features of spinal cord
okoche

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Source:  OpenStax, Anatomy & Physiology. OpenStax CNX. Feb 04, 2016 Download for free at http://legacy.cnx.org/content/col11496/1.8
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