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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

life circle of RBC and the life circle of WBC.
Yemi Reply
RBC 120days
Zeph
RBC 120days and WBC 10-12days
sai
what is anatomy?
Md Reply
positive feedback mechanism
Sirimala Reply
what is immunology
Riya Reply
immunology is a branch of medicine that study's the body immune system
SAMUEL
Immunology This is the study of specific and non-specific resistance of the body against infection i.e. the study of the immune response of a host to a foreign substance, which includes study of various reactions which are induced in the body by introduction of a substance.
Kaluki
what is role of elimination need like fluid and also stools
Munmun Reply
bone
Vijay
what is joint pain
Vijay
is the physical suffering caused by illness or injury of the joint
malulu
pls can someone describe shock,types ,pathophysiology and treatment
Isaac
this is what I'm thinking "After taking out everything the body needs, the bowel then expels the leftover waste."
isaiah
I think elimination also helps in the continuation of the digestive system because if the unwanted fluids and stools does not come out of the system it can create a problem in the digestive. system resulting in diseases.
Martha
shock is a condition whereby the circulating system is unable to get enough blood and oxygen to vital organs like the brain,heart,eye,kidney and others.
Martha
causing depression of those organs.
Martha
there are 2 classification of shock. primary shock: this occurs immediately after injury due emotional stimulus or pain.example hearing a bad news,sudden obstruction of airway.sudden heart attack. secondary shock :it occurs when primary shock is delayed
Martha
types of shock syncope (faint) oligaemic or hyppvovaemic shock. Anaphylactic shock. neurogenic/ physical shock septic sock catdiogenic shock.
Martha
What is the difference between dna duplication and chromosomes duplication?
to help you identify the human body parts to help you live a healthy life the study of Anatomy helps one to work in any health sector
sophia Reply
okay.
what is the function of the mitochondrial in the cell
Vida Reply
define and explain the synovial membrane
Mahmudu Reply
What is cloning?
Jesam Reply
relationship between anatomy and physiology
Ranjeeta Reply
anatomy is the structure and physiology is the function
Isaac
the branches of physiology
Asiedu Reply
is single DNA arranged into 46 chromosomes
Vaishnavi Reply
don't know about it
Sachin
no it is duble strand or pair of chromosomes
Marta
how does muscle contraction work?
Matthew
no,it is arranged as 23 pairs chromosomes
Ajiola
what are the parts of a cell?
Noel Reply
cell body, nucleus, cytoplasm, endoplasmic reticulum (rough and smooth), Golgi apparatus, cell membrane and organelles.
Heather
cell membrane, cell wall,cytoplasm, nucleus, etc
Felix
explain how skeletal muscles work
Felix
they work voluntarily
Trina
46 chromosomes present in which part of human body
Anar
when twins born how both of them carry 46 chromosomes
Anar
In the nuclear membrane
wisdom
but thiere r many cells n definetely cells have many nuclear membrane
Anar
cytoplasm plasma membrane nucleus
Ajiola
nucleus cytoplasm epr spr mitochondria
sureshbabu
cell have many parts and it act as different function s
sureshbabu
lysosome, golge body, cytoplasm, smooth endoplasmic reticulum
Vida
what is sex with male and female!
Muhammad Reply
intercourse
Jessie
sexual intercourse
Jessie
for formation of new generation
Sunil
sex is a female and male body courtship, rubbing of penis and vagina which results in release of fluids (sperm) from male in to the vagina of the female know as ejaculation
CHUOL
sex is a body courtship, penis and vagina rubbing which results in release of fluids sperm)
CHUOL
how sure a u?
Pius
it's like copulation
Pius

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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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