Intrinsic Regulation of Heart Pumping The Frank Starling Mechanism

In Chapter 20, we will learn that under most conditions, the amount of blood pumped by the heart each minute is determined almost entirely by the rate of blood flow into the heart from the veins, which is called venous return. That is, each peripheral tissue of the body controls its own local blood flow, and all the local tissue flows combine and return by way of the veins to the right atrium. The heart, in turn, automatically pumps this incoming blood into the arteries, so that it can flow around the circuit again.

This intrinsic ability of the heart to adapt to increasing volumes of inflowing blood is called the Frank-Starling mechanism of the heart, in honor of Frank and

Starling, two great physiologists of a century ago. Basically, the Frank-Starling mechanism means that the greater the heart muscle is stretched during filling, the greater is the force of contraction and the greater the quantity of blood pumped into the aorta. Or, stated another way: Within physiologic limits, the heart pumps all the blood that returns to it by the way of the veins.

What Is the Explanation of the Frank-Starling Mechanism?

When an extra amount of blood flows into the ventricles, the cardiac muscle itself is stretched to greater length. This in turn causes the muscle to contract with increased force because the actin and myosin filaments are brought to a more nearly optimal degree of overlap for force generation. Therefore, the ventricle, because of its increased pumping, automatically pumps the extra blood into the arteries.

This ability of stretched muscle, up to an optimal length, to contract with increased work output is characteristic of all striated muscle, as explained in Chapter 6, and is not simply a characteristic of cardiac muscle.

In addition to the important effect of lengthening the heart muscle, still another factor increases heart pumping when its volume is increased. Stretch of the right atrial wall directly increases the heart rate by 10 to 20 per cent; this, too, helps increase the amount of blood pumped each minute, although its contribution is much less than that of the Frank-Starling mechanism.

Ventricular Function Curves

One of the best ways to express the functional ability of the ventricles to pump blood is by ventricular function curves, as shown in Figures 9-8 and 9-9. Figure 9-8 shows a type of ventricular function curve called the stroke work output curve. Note that as the atrial pressure for each side of the heart increases, the stroke work output for that side increases until it reaches the limit of the ventricle's pumping ability.

Figure 9-9 shows another type of ventricular function curve called the ventricular volume output curve. The two curves of this figure represent function of the two ventricles of the human heart based on data extrapolated from lower animals. As the right and left atrial pressures increase, the respective ventricular volume outputs per minute also increase.

Thus, ventricular function curves are another way of expressing the Frank-Starling mechanism of the heart. That is, as the ventricles fill in response to higher atrial pressures, each ventricular volume and strength of cardiac muscle contraction increase, causing the heart to pump increased quantities of blood into the arteries.

Control of the Heart by the Sympathetic and Parasympathetic Nerves

The pumping effectiveness of the heart also is controlled by the sympathetic and parasympathetic (vagus) nerves, which abundantly supply the heart, as shown in Figure 9-10. For given levels of input atrial pressure, the amount of blood pumped each minute (cardiac output) often can be increased more than 100 per cent by sympathetic stimulation. By contrast, the output can be decreased to as low as zero or almost zero by vagal (parasympathetic) stimulation.

Mechanisms of Excitation of the Heart by the Sympathetic

Nerves. Strong sympathetic stimulation can increase the heart rate in young adult humans from the normal rate of 70 beats per minute up to 180 to 200 and, rarely, even 250 beats per minute. Also, sympathetic stimulation increases the force of heart contraction to as much as double normal, thereby increasing the volume of blood pumped and increasing the ejection pressure.

Frank Starling Curve

Figure 9-8

Left Atrial Pressure Curve
Atrial pressure (mm Hg)

Figure 9-8

Left and right ventricular function curves recorded from dogs, depicting ventricular stroke work output as a function of left and right mean atrial pressures. (Curves reconstructed from data in Sarnoff SJ: Myocardial contractility as described by ventricular function curves. Physiol Rev 35:107, 1955.)

Figure 9-9

Approximate normal right and left ventricular volume output curves for the normal resting human heart as extrapolated from data obtained in dogs and data from human beings.

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Frank Starling Curve

Figure 9-10

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Essentials of Human Physiology

Essentials of Human Physiology

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    What is intrinsic regulation of the heart?
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