VENTRICULAR PRESSURE VOLUME LOOP
This presentation is the property of its rightful owner.
Sponsored Links
1 / 42

VENTRICULAR PRESSURE VOLUME LOOP PowerPoint PPT Presentation


  • 112 Views
  • Uploaded on
  • Presentation posted in: General

VENTRICULAR PRESSURE VOLUME LOOP. Dr. G. Gnanavelu , MD, DM Associate Professor and Head Department of Cardiology Kilpauk Medical College Chennai. CARDIAC CYCLE. VENTRICULAR PRESSURE VOLUME LOOP. ESPVR. AoV closes. LV pressure (mmHg). AoV opens. MV closes. MV opens. EDPVR.

Download Presentation

VENTRICULAR PRESSURE VOLUME LOOP

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Ventricular pressure volume loop

VENTRICULAR PRESSURE VOLUME LOOP

Dr. G. Gnanavelu, MD, DM

Associate Professor and Head

Department of Cardiology

KilpaukMedical College

Chennai


Ventricular pressure volume loop

CARDIAC CYCLE


Ventricular pressure volume loop

VENTRICULAR PRESSURE VOLUME LOOP

ESPVR

AoV

closes

LV pressure (mmHg)

AoV opens

MV closes

MV

opens

EDPVR

LV volume (ml)

PRESSURE &

VOLUME MEASUREMENT

Conductance catheter

Volume by echo

Pressure by high fidelity manometer

APPLICATION

Clinical tool;

Experimental

200

100

0

0 100 200


Ventricular pressure volume loop

LEFT ATRIALPRESSURE VOLUME LOOP


Ventricular pressure volume loop

VENTRICULAR PRESSURE VOLUME LOOP


Ventricular pressure volume loop

AoV

closes

LV pressure (mmHg)

AoVopens

MV closes

MV

opens

LV volume (ml)

GENERATION OF PRESSURE VOLUME LOOP

1 = MV closing point

2 = MV opening point

3 = Ao V closing point

4 = Ao V opening point

a = Diastole

b = Isovolumic

contraction

c = Systole

d = Isovolumic

relaxation

c

200

100

0

3

2

stroke volume

d

b

1

a

4

0 100 200


Ventricular pressure volume loop

DETERMINANTS OF VENTRICULAR FUNCTION

Preload: initial stretching of the cardiac myocytes prior to contraction.

clinical index: end diastolic volume or end diastolic pressure

Afterload: the load against which the ventricle ejects

clinical index: Aortic pressure (in the absence of LVOT obstruction)

or precisely wall stress

Contractility:the intrinsic ability of a cardiac muscle fibre to contract at a

given fibre length.

Heart rate


Ventricular pressure volume loop

FRANK-STARLING CURVE

100

50

0

100

50

0

B

INCREASED VENOUS RETURN

A

SV (ml)

SV (ml)

C

DECREASED VENOUS RETURN

0 10 20

0 10 20

LVEDP (mmHg)

normal

‘Stroke volume increases proportionately with preload within physiologic limits’


Ventricular pressure volume loop

FAMILY OF FRANK STARLING CURVES

100

50

0

100

50

0

SV (ml)

SV (ml)

0 10 20

0 10 20

LVEDP (mmHg)

Afterload

Inotropy

Afterload

Inotropy

‘Increased afterload and decreased inotropy shifts the curve downward – SV decreases’

‘Decreased afterload and increased inotropy shifts the curve upwards – SV increases’


Ventricular pressure volume loop

INOTROPY & FORCE VELOCITY RELATIONSHIP

Shortening velocity

Normal

Increased

inotropy

Decreased

inotropy

Afterload (force)

As afterload increases; shortening velocity decreases -- SV decreases;

As afterload decreases, shortening velocity increases – SV increases;

At a given afterload; increasing inotropy increases shortening velocity;


Ventricular pressure volume loop

PRELOAD & FORCE VELOCITY RELATIONSHIP

Shortening velocity

Increasing preload a c

c

b

a

Afterload (Force)

As afterload increases; shortening velocity decreases -- SV decreases;

As afterload decreases, shortening velocity increases – SV increases;

At a given afterload; increasing preload increases shortening velocity;


Ventricular pressure volume loop

VENTRICULAR COMPLIANCE CURVE

100

50

0

LV pressure (mmHg)

Decreased compliance

normal

EDP

0 100 200

EDV

DIASTOLIC PRESSURE VOLUME RELATIONSHIP

Increased compliance

‘Slope of the curve is stiffness; Compliance is the inverse of the slope’

‘As compliance decreases; filling pressure increases’


Ventricular pressure volume loop

END SYSTOLIC PRESSURE VOLUME RELATIONSHIP

inotropy

ESPVR

normal

inotropy

LV pressure (mmHg)

200

100

0

EDPVR

LV volume (ml)

0 100 200


Ventricular pressure volume loop

NORMAL PRESSURE VOLUME LOOP

ESPVR

AoV

closes

LV pressure (mmHg)

AoV opens

MV closes

MV

opens

EDPVR

LV volume (ml)

systole

200

100

0

IVC

IVR

Normal IVR & IVC

diastole

0 100 200

Abnormal IVR & IVC


Ventricular pressure volume loop

INCREASED PRELOAD

INCREASED PRELOAD

DECREASED PRELOAD

DECREASED PRELOAD

200

100

0

200

100

0

L V pressure (mm Hg)

L V pressure (mm Hg)

0 100 200

0 100 200

EDV

EDV

ESV

ESV

LV volume (ml)

LV volume (ml)

CHANGES IN PRELOAD AND STROKE VOLUME

Primary change: EDV increases; SV increases

Secondary change : ESV increases minimally

Primary change: EDV decreases; SV dereases

Secondary change : ESV decreases minimally


Ventricular pressure volume loop

INCREASED AFTERLOAD

INCREASED AFTERLOAD

DECREASED AFTERLOAD

DECREASED AFTERLOAD

200

100

0

200

100

0

L V pressure (mm Hg)

L V pressure (mm Hg)

0 100 200

0 100 200

EDV

EDV

ESV

ESV

LV volume (ml)

LV volume (ml)

CHANGES IN AFTERLOAD AND STROKE VOLUME

Primary change: ESV increases; SV decreases

Secondary change : EDV increases minimally

Primary change: ESV decreases; SV increases

Secondary change : EDV decreases minimally


Ventricular pressure volume loop

CHANGES IN INOTROPY AND STROKE VOLUME

INCREASED INOTROPY

DECREASED INOTROPY

200

100

0

200

100

0

L V pressure (mm Hg)

L V pressure (mm Hg)

0 100 200

0 100 200

EDV

EDV

ESV

ESV

LV volume (ml)

LV volume (ml)

Primary change: ESV decreases; SV increases

Secondary change : EDV decreases minimally

Primary change: ESV increases; SV decreases

Secondary change : EDV increases minimally


Ventricular pressure volume loop

ABNORMAL PRESSURE VOLUME LOOP

ESPVR

AoV

closes

LV pressure (mmHg)

AoV opens

MV closes

MV

opens

EDPVR

LV volume (ml)

  • Identified by

  • Change in EDPVR & EDP

  • Change in ESPVR & pressure

  • at which AoV closes

  • Change in Stroke volume

  • Curved IVC & IVR line

  • Overall shape of PV loop

systole

200

100

0

IVC

IVR

diastole

0 100 200


Ventricular pressure volume loop

SYSTOLIC DYSFUNCTION

200

100

0

100

50

0

loss of inotropy

L V pressure (mm Hg)

Stroke volume (ml)

NORMAL

SYSTOLIC DYSFUNCTION

VASODILATORS

0 100 200

0 10 20 30

EDV

ESV

LV volume (ml)

LV EDP (mm Hg)

Loss of inotropy shifts ESPVR downwards; ESV increases, Compensatory increase in EDV to some extent; SV decreases.

Frank Starling curve : shifts downwards; EDP increases. SV falls; With vasodilator therapy, SV improves; EDP is reduced.


Ventricular pressure volume loop

DIASTOLIC DYSFUNCTION

200

100

0

L V pressure (mm Hg)

100

50

0

LV pressure (mmHg)

Decreased compliance

normal

EDP

0 100 200

EDV

LV volume (ml)

0 100 200

EDV

ESV

LV volume (ml)

eg. LVH; compliance curve shifts up. EDP increases and SV decreases.

Careful use of diuretics will be of use; because some degree of raised venous pressure is necessary to fill less compliant ventricle.


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

MITRAL STENOSIS

Decrease in EDV since there is reduced filling.

SV decreases, fall in CO and Aortic pressure.

Afterload is decreased so ESV also decreases to some extent.


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

AORTIC STENOSIS

Afterload is very much increased, so ESV increases and SV decreases

As ESV increases, residual volume is added to venous return, so EDV increases.

Increased preload increases force of contraction and maintains SV to some extent

Diuretics are deleterious in this situation


Ventricular pressure volume loop

CHRONIC AORTIC REGURGITATION

200

100

0

No true Isovolumic contraction and relaxation

EDV increases greatly.

This increases Stroke volume and cardiac output.

Afterload increases hence ESV also increases to some extent.

Once systolic dysfunction sets in, ESV increases progressively and peak systolic pressure & SV fall

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)


Ventricular pressure volume loop

ACUTE AORTIC REGURGITATION

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

Ventricular diastolic volume increases suddenly

EDV and EDP increases

PV loop appears small

No true isovolumic relaxation

SV falls


Ventricular pressure volume loop

CHRONIC MITRAL REGURGITATION

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

EDV increases

No true isovolumic contraction and relaxation

Afterload is reduced, so ESV is reduced

Net effect = SV increases

With systolic dysfunction; ESV increases, forward stroke volume decreases


Ventricular pressure volume loop

ACUTE MITRAL REGURGITATION

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

Ventricular volume increases abruptly

No true isovolumic contraction

EDP rapidly increases

PV loop appears small


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

CARDIAC TAMPONADE

Unique PV loop

Preload is greatly decreased;

EDP is elevated

ESV is also decreased

Stroke volume is decreased


Ventricular pressure volume loop

LV pressure (mmHg)

LV volume (ml)

PV LOOP - QUIZ

Where does Aortic valve close?

Point 1

Point 2

Point 3

4. Point 4

c

200

100

0

3

2

d

b

1

a

4

0 100 200


Ventricular pressure volume loop

LV pressure (mmHg)

LV volume (ml)

PV LOOP - QUIZ

Where does Mitral valve open?

Point 1

Point 2

Point 3

4. Point 4

c

200

100

0

3

2

d

b

1

a

4

0 100 200


Ventricular pressure volume loop

LV pressure (mmHg)

LV volume (ml)

PV LOOP - QUIZ

Which portion of the loop is

systole

Shaded area

Unshaded area

200

100

0

0 100 200


Ventricular pressure volume loop

LV pressure (mmHg)

LV volume (ml)

PV LOOP - QUIZ

What is the abnormality ?

Why ?

200

100

0

0 100 200


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

PV LOOP - QUIZ

What does the blue line with arrows indicate?

Cardiac output

Stroke volume

Stroke work

Kinetic energy


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

INTERPRETING PV LOOP

30 yr old male

Hb 8 gms%

C/o SOB & palpitation

BP 130/70

What is the abnormality?


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

INTERPRETING PV LOOP

What has caused the change in the shaded pressure volume loop?

Intravenous fluids

Diuretics

ACE inhibitors

Dobutamine


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

INTERPRETING PV LOOP

What has caused the change in the shaded pressure volume loop?

Intravenous fluids

Diuretics

ACE inhibitors

Dobutamine


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

INTERPRETING PV LOOP

30 yr old male

With acute gastroenteritis

Pulse thready and rapid

BP 80 systolic

Clear lungs

What is the abnormality in PV loop ?


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

INTERPRETING PV LOOP

50 yr old male

Hypertensive

Old ASMI

c/o SOB Class III

BP 150/100

ECHO: RWMA;

EF 38%

What are the changes seen in

Colored PV Loop?


Ventricular pressure volume loop

INTERPRETING PV LOOP

200

100

0

Same patient

After three months of drugs

SOB Class III

BP 120/80

ECHO: RWMA;

EF 45%

What are the drugs which have caused the changes in PV loop?

L V pressure (mm Hg)

After drugs

Before drugs

0 100 200

EDV

ESV

LV volume (ml)


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

INTERPRETING PV LOOP

65 yr. old female

Hypertensive

c/o SOB Class III

BP 160/100

S4

Bil. basal rales

ECHO: Mod. Conc. LVH

EF 60%

Why is the patient dyspneic on exertion?


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

INTERPRETING PV LOOP

25 yr. old male

Bicuspid aortic valve

No RF delay

BP 140/70

What are the hemodynamic

changes seen in PV loop?

What are the lesions?


Ventricular pressure volume loop

200

100

0

L V pressure (mm Hg)

0 100 200

EDV

ESV

LV volume (ml)

INTERPRETING PV LOOP

60 year old male

Calcific aortic stenosis – severe (blue PV loop)

After 3 years – (green PV loop)

What are the changes?

What will be the clinical findings?


  • Login