ANZCA Primary
Physiology
Cardiac
High Evidence

Cardiovascular Physiology

The cardiovascular system maintains perfusion to all tissues through coordinated heart function, vascular tone, and blood volume regulation. Cardiac output (CO): 5-6 L/min (HR 60-100 bpm × SV 60-100 mL); determined by...

Updated 2 Feb 2026
2 min read
Citations
86 cited sources
Quality score
54 (gold)

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Urgent signals

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  • Cardiogenic shock with low cardiac output
  • Severe arrhythmias compromising perfusion
  • Acute coronary syndrome with ST elevation
  • Pulmonary oedema with respiratory failure

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  • ANZCA Primary Written
  • ANZCA Primary Viva

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ANZCA Primary Written
ANZCA Primary Viva

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Clinical reference article

Quick Answer

The cardiovascular system maintains perfusion to all tissues through coordinated heart function, vascular tone, and blood volume regulation. Cardiac output (CO): 5-6 L/min (HR 60-100 bpm × SV 60-100 mL); determined by preload (venous return, Frank-Starling mechanism), contractility (inotropy, catecholamines, calcium), afterload (SVR, arterial impedance), heart rate. Frank-Starling law: Increased ventricular end-diastolic volume (preload) increases stroke volume up to physiological limit; beyond this, further stretch reduces contractility (ventricular failure). Blood pressure: MAP = CO × SVR; normal MAP 70-105 mmHg; systolic pressure determined by stroke volume and arterial compliance, diastolic pressure determined by SVR and arterial elasticity. Autonomic control: Sympathetic (β1 receptors—HR, contractility; α1 receptors—vascular constriction); parasympathetic (vagus—reduces HR, minimal vascular effect); baroreceptor reflex (carotid and aortic arch sensors maintain BP via rapid HR and vascular adjustments). Coronary circulation: Left coronary (LAD, circumflex—supplies LV, anterior septum, lateral wall), right coronary (supplies RV, inferior wall, SA/AV nodes in most); coronary perfusion occurs during diastole (80%), especially important in tachycardia (reduced diastolic time); autoregulation maintains flow across MAP 60-180 mmHg. Electrophysiology: SA node pacemaker (60-100 bpm), AV node delay (0.1 sec), Purkinje conduction; action potential phases (0—fast Na+ influx, 1—transient K+ efflux, 2—Ca2+ influx plateau, 3—K+ efflux repolarization, 4—resting); refractory periods prevent tetany. Anaesthetic implications: Most anaesthetics reduce myocardial contractility and vasodilate (reduce afterload); compensate with fluids, vasopressors; volatile agents preserve autoregulation better than IV agents; ketamine maintains BP via sympathetic stimulation; propofol causes profound vasodilation and myocardial depression. Vascular function: Arteries (pressure reservoir, compliance), arterioles (resistance vessels, regulated by autonomic and local factors), capillaries (exchange), veins (capacitance vessels, 70% blood volume). Indigenous populations: Higher rates of cardiovascular disease (2-3×); careful assessment and management of coronary risk essential. [1-10]