Determinants of Stroke Volume.







  I.  Ventricular Preload


  A.  Blood volume

  B.  Distribution of blood volume

  •       Body position
  •      Intrathoracic pressure
  •      Intrapericardial pressure
  •      Venous tone
  •      Pumping action of skeletal muscles
  C.  Atrial contraction


 II.  Ventricular Afterload

  A.  Systemic vascular resistance

  B.  Elasticity of arterial tree

  C.  Arterial blood volume

  D.  Ventricular wall tension
  •       Ventricular radius
  •       Ventricular wall thickness


III.  Myocardial Contractility

  A.  Intramyocardial [Ca 2+ ] ↑↓

  B.  Cardiac adrenergic nerve activity ↑↓ 

  C.  Circulating catecholamines ↑↓ 

  D.  Cardiac rate ↑↓ 

  E.  Exogenous inotropic agents ↑

  F.  Myocardial ischemia ↓

  G. Myocardial cell death (necrosis, apoptosis, autophagy) ↓

  H. Alterations of sarcomeric and cytoskeletal proteins ↓
  •       Genetic
  •      Hemodynamic overload
  I.  Myocardial fibrosis ↓

  J.  Chronic overexpression of neurohormones ↓

  K.  Ventricular remodeling ↓

  L.  Chronic and/or excessive myocardial hypertrophy ↓



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