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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

what is ventricular circulation
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what factors that affect the rate diffusion
Gift Reply
sorry what are the common meaning of haemostatis
Juma Reply
what are the negatives feedback regulation of ADH
Nansi Reply
what is the the differences between DNA and RNA?
Mustapha
The major differences between the DNA and RNA are contain of double stranded and single stranded which the DNA contain duoble stranded and RNA contain single stranded.
Juma
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Juma
How many genes consist of DNA?
Omaryare
omaryare muhyadiin when you talk about genes, is the material formed in a DNA genes have form like plasma have many genes round there
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aldosterone, renin
Conan
to know the different structures of the body To know how the body works To know more about our body parts
Deitdre Reply
hi Deitdre you tock about knowledge or you ask the question
Juma
do you need any explanation when reading this book?
janet Reply
Its Good
Hashir
yes
Balogun
Yes
Mariam
yes
Sale
yes
Mustapha
if have many ability just do it!!
Juma
compare and contrast the operation of homeostasis
Dinelle Reply
what is the difference between an ionic, polar covalent and nonpolar covalent bond?
Dinelle
In summary, the bond has different in electronegativity.
Balogun
sorry help me to get the definition of hemostasis or the meaning
Juma
the definition of distal
Dinelle Reply
farthest away from the attachment point.
felix
Distal, is the farthest possition from the origin or midle point
Juma
exercise physiologist how ?
Noor Reply
hi noorr. when you talk about physiologist its a person who study physiology but exercise physiologist is what an exercise doing by physiologist in physiologican
Juma
can I get the questions of human physiology that is present in HSC 2nd semester
Rafiullah Reply
in my lerning the question com like for example ni eassy qustion must understand the the part of the body and how it work or mechanisms of each part learned
Juma
how can I memorize
mukhtaar Reply
which part of the body produces blood
aadil
give me answer
aadil
Red blood cells are formed in the red bone marrow ofbones. Stem cells in the red bone marrow called hemocytoblasts give rise to all of the formed element
mukhtaar
what is hemocytoblasts
Fatima
hemocytoblasts are stem cells in red bone marrow which give rise the all of formed elements
Khawaja
Discuss clonal theory in physiology and its application in measles infection in a 6yr child? Can anyone help me
Isaac Reply
Capillary permeability
what do you want to know about it?
Ramsin
Hello, I want to search about the topic, information and pictures
syncitium is the property of which of the following muscle
Shahab Reply
can I get the questions of human physiology that is present in HSC 2nd semester
Sai Reply
i now madam
irpa
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Sai
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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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