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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

In what time stomach empty it's content in to doudemun? what is chyme?
Sneha Reply
write the chemical and mechanical digestion which occurs in stomach?
Sneha
Does absorption take place in stomach? what are absorption in the stomach by which cell?
Sneha
Chemical digestion---Mixtures of the food with the gastric acid Mechanical digestion--- churning of the food in the stomach making it become more involved into chyme
Mercy
absorption takes place in the small intestine because of the presence of the villi
Enada
name the muscles supplied redina nerve
Appu Reply
mechanism of hormone releasing by gland
said Reply
why is muscle tissue not considered to be a type of connective tissue?
Ezel Reply
A Skeletal muscles consist of numerous muscles cells called Muscle Fibers . Three layers of connective tissues surrounded these fibers to make the muscles tissues
Manisha
that's wny connective tissues is not considered as muscles fibers
Manisha
there are 4 types of tissues : epithelial, connective tissue, nervous tissue and muscle tissue, each one has its own properties. The main function of connective tissue is nutrition, it supplies nutrientes to epithelial tissues that are responsible for protection.
Ariete
Muscle tissue has properties that allow movement, the function here is movement and not nutrition like connective tissue.
Ariete
In what time stomach empty it's content in to doudemun?
Sneha
write the chemical and mechanical digestion which occurs in stomach?
Sneha
Does absorption take place in stomach? what are absorption in the stomach by which cell?
Sneha
Does absorption take place in stomach? what are the absorption in the stomach by which cell?
Sneha
mechanism of hormone controlling releasing by gland
said
please can someone explain renin angiotensin aldosteron system for me
okolie
name the joint present between epichysif and diachysif
JAYKISHAN Reply
what is arteries
JAYKISHAN
oxygenated blood carrying vessels
Karanpreet
I think oxygenated blood carrying pulmonary vein
Omaryare
ya this stetment is right 4 pulmonary vein carrying the oxygenated blood
Sneha
What is the relation between cold and clammy skin and disorders that cause poor perfusion?
Tyrone Reply
name the instruments used to measure the gas volume and flow in pulmonary function test
Preethi Reply
Spirometer
Ravi
In a spirometry test, While you are sitting, you breath into a mouthpiece that is connected to an instrument called a spirometer . The spirometer records the amount and the rate of air that you breath in and out over a period of time. When standing, Some numbers might be slightly different.
Ravi
tq soo much
Preethi
u most wlcm
Ravi
what is signal transduction?
Bahle
Signal Transduction (Also know as cell signaling) is the transmission of molecular signal from a cell exterior to its interior.Signals receive by cells must be transmitted effectively into the cell to ensure an appropriate response. This step is initiated by cell - surface receptors.
Ravi
i know now didn't know
Cypline
that's great respond
Feng
what is histological anatomy?
Thelma Reply
what is histological anatomy?
Thelma
the study of form of structure seen under the microscope
Metinah
is the branch of biology which studies the microscopic anatomy of biological tissues.
Jeffrey
it's the study of the microscopic anatomy of cells and tissues in the plants and it's carried out by examining a thin slice of tissues under a microscope light / or an electronic microscope
Manisha
is the study of anatomy in a microscopic level
simon
thank you
Thelma
what are the significance differrences can be donated between the female and male skeleton..
charles
What is Ions and Ionic bonds
Ravi Reply
2 less stable atoms
Hope
Ionic bonding is the complete transfer of valence electron(s) between atoms. It is a type of chemical bond that generates two oppositely charged ions. In ionic bonds, the metal loses electrons to become a positively charged cation, whereas the nonmetal accepts those electrons to become a negatively
Hope
what is osmosis
Brown Reply
it's out Body Fluid.
Sa
high pressure to low pressure flow
Sneha
Osmosis is the movement of solvent from a region of lower solute concentration to a region of higher solute concentration through a semi- permeable membrane.
Ravi
how many types of tissue
ABBAKARR Reply
4, that is muscle tissue, connective, nerve and epithelial tissue
Mapesho
We have four types of tissue these are ,epithelial tissue,nerve tissue,muscle tissue and connective tissue
Samboat
function of labia minora
temba
why is a graph of plasma [glucose] superimposed
Sefai Reply
what is biosphere
Jenessa Reply
supporting life
Diana
it is the part of the earth and its atmosphere capable of supporting life
Diana
what is the function of villus?
Grant Reply
absorption of nutrients
SELTON
They have a large surface area so there will be more efficient absorption of fatty acids and glycerol into the blood stream.
moribo
what is the relationship between heart and lungs
Prisca
when blood inter the rihgt ventricle the blood is inpure through the pumps blood rich the luns there blood exchange pure
Sneha
blood ( inpure blood exchange in to pure blood
Sneha
I don't understand what these messages are about.
Daniel
I gave you all the information I could think of. What is next?
Daniel
if you were to poke a pin in the greater omentum how many layers of simple squamous epithelium would it pass
MrLinear Reply

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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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