Left Ventricular

Pressure-Volume Loops

Left Ventricular
Pressure-Volume Loops
Pressure-volume
loop plots LV
pressure against LV
volume through one
complete cardiac
cycle

Factors affecting:

Preload
Afterload
Contractility
IHSS
Valvular problems

Left Ventricular
Pressure-Volume Loops

KNOW:
1. When the mitral and aortic valves are
open and closed during each phase
2. When systole begins (B) and ends (D)
3. When diastole begins (D) and ends (B)
4. Diastolic filling occurs between points
A and B
5. Ejection occurs between points C and
D

Left Ventricular
Pressure-Volume Loops
Acute changes in
preload
Increased preload:
Filling increases
SV increases

Decreased
preload:
Filling decreases
SV decreases

*NOTE: the ventricle

empties to the
same end-systolic
volume after either
an increase or
decrease in preload

Left Ventricular
Pressure-Volume Loops

Left Ventricular
Pressure-Volume Loops
Cardiac tamponade
Unique loop

Left Ventricular
Pressure-Volume Loops
Acute changes in
Afterload
Increased
afterload:
Ventricle empties
less completely
SV decreases
Increase in BP
(shifts up and right)

Decreased
afterload:
Ventricle empties
more completely
SV increases
Decrease in BP
(shifts down and
left)

Left Ventricular
Pressure-Volume Loops

Left Ventricular
Pressure-Volume Loops
Altered
contractility
Increased
contractility:
Ventricle empties
more completely
SV increases
BP increases
(shifts up and left)

Decreased
contractility:
Ventricle empties
less completely
SV decreases
BP decreases
(shifts down and
right)

Left Ventricular
Pressure-Volume Loops

Left Ventricular
Pressure-Volume Loops
Summary of concepts:
Alterations in preload: end-diastolic volume
increases or decreases, but the amount of blood in
the chamber at end-systole does not change
Stroke volume falls: result of either an increase in
afterload or a decrease in contractility, the volume
of blood in the LV chamber increases (chamber
dilates)
Stroke volume increases: result of a decrease in
afterload or an increase in contractility, the volume
of blood in the LV chamber decreases (chamber
shrinks)

Left Ventricular
Pressure-Volume Loops
IHSS
UNIQUE
P-V loop is shifted to
smaller volumes and
larger pressures (due
to outflow tract
obstruction)
ONLY IHSS causes this
type of combined shift

Left Ventricular
Pressure-Volume Loops
Chronic Aortic
Stenosis
(increased afterload)
Concentric
hypertrophy permits
the LV to generate
greater pressure
LV volumes remain
about normal
P-V loop shifts upward

Left Ventricular
Pressure-Volume Loops
Mitral Stenosis
(Decreased preload)
LV filling is
diminished
P-V loop reflects a
decreased preload
Emptying is about
normal

Left Ventricular
Pressure-Volume Loops
Acute Aortic
Insufficiency
(regurgitation)
Volume in the LV
chamber increases
during early diastole
P-V loop is small
No isovolemic
relaxation

Left Ventricular
Pressure-Volume Loops
Chronic Aortic
Insufficiency
(Eccentric
hypertrophy)
LV chamber dilates
P-V loop is large
because the SV is
large
No isovolemic
relaxation

Left Ventricular
Pressure-Volume Loops
Be able to identify a P-V loop that
shows aortic insufficiency
Be able to identify whether the loop
reflects acute or chronic aortic
insufficiency

Left Ventricular
Pressure-Volume Loops
Acute Mitral
Regurgitation
P-V loop is small
No isovolemic
contraction

Left Ventricular
Pressure-Volume Loops
Chronic Mitral
Regurgitation
LV hypertrophies
(eccentric)
LV chamber dilates
P-V loop is large
because the SV is
large
No isovolemic
contraction

Left Ventricular
Pressure-Volume Loops
A = Normal
B = Mitral
stenosis
C = Aortic
stenosis
D = mitral
regurgitation
(chronic)
E = aortic
regurgitation
(chronic)