Cardiovascular centre is detected by baroreceptors in the aortic sinuses or carotid sinuses, the cardiovascular centre affects changes to the heart rate by sending a nerve impulse to the cardiac pacemaker (or SA node) via sympathetic fibres (to cause faster and stronger cardiac muscle contraction) and the vagus nerve (to cause slower and less strong cardiac muscle contraction). The cardiovascular centre also increases the stroke volume of the heart (that is, the amount of blood it pumps). These two changes help to regulate the cardiac output, so that a sufficient amount of blood reaches tissue. Hormones like epinephrine and norepinephrine can affect
Cardiac contractility modulation the electrical non-excitatory state of the cardiac muscle cells (the absolute refractory period) cause an increase in myocyte calcium in the cytosol during systole. This increases the muscle contraction strength. Additionally, within minutes, cell metabolism and gene expression, which are typically abnormal in heart failure, improve towards their normal state. This beneficial effect occurs initially only in the area adjacent to the electrodes, but with time also spreads to remote areas of the cardiac muscle. Cardiac contractility modulation therefore restores the structure and function of damaged cells back towards their normal state. In some cases, disease-related changes in the ventricular