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Left Ventricular Function Frank-Starling Principle Left Ventricular Failure. Jeffrey Groom, MS, CRNA, ARNP Associate Professor Anesthesiology Nursing Program Florida International University - Miami, Florida. Volume (Preload). Ventricular Output. Cardiac Output. Atrial Input.

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left ventricular function frank starling principle left ventricular failure

Left Ventricular FunctionFrank-Starling PrincipleLeft Ventricular Failure

Jeffrey Groom, MS, CRNA, ARNPAssociate Professor Anesthesiology Nursing Program Florida International University - Miami, Florida

concept of ventricular function curve

Volume

(Preload)

Ventricular Output

Cardiac

Output

Atrial Input

Right or Left Heart

Concept of Ventricular Function Curve
ventricular function curve
Ventricular Function Curve

OUTPUT(BP, CO, SV, CI, SWI)

VOLUME(LVEDV, LVEDP, LAP, PCWP)

right and left ventricular function curves

Cardiac

Output

Right Ventricle

Left Ventricle

Normal CO

5000 ml/min

0

3

Atrial Pressure (Preload)

Normal RAP

Normal LAP

Right and Left Ventricular Function Curves

Right CO = Left CO

ventricular function curve5
Ventricular Function Curve

OUTPUT(BP, CO, SV, CI, SWI)

PRELOAD(LVEDV, LVEDP, LAP, PCWP)

lv pressure volume loop

Ejection

Systolic Curve

LV

Pressure

IVC

Diastolic Curve

SV

IVR

LV Volume

ESV

EDV

Filling

LV Pressure-Volume Loop
frank starling principle
Frank-Starling Principle

Relationship between cardiac output and left ventricular end-diastolic volume is dictated by the Frank-Starling Principle.

frank starling s law of the heart

Maximum Capacity

To Produce SV

Stroke

Volume

Normal Range:

SV increases with EDV

End-Diastolic Volume

Mechanism: Length-Force Relations of Muscle Contraction

Frank-Starling’s Law of the Heart
lv pressure volume loop and frank starling s law

Systolic Curve

LV

Pressure

SV2

Diastolic Curve

SV1

LV Volume

ESV

EDV1

EDV2

LV Pressure-Volume Loop andFrank-Starling’s Law

EDV2 > EDV1

SV2 > SV1

family of frank starling curves

At a given EDV, SV increases

With cardiac contractility

High

Stroke

Volume

Increase in

Cardiac

Contractility

Low

Preload (End-Diastolic Volume)

Family of Frank-Starling Curves
family of cardiac function curves

Increase in

Cardiac

Contractility

or

Increase in

Heart Rate

Cardiac

Output

Right Atrial Pressure

Family of Cardiac Function Curves
family of ventricular function curves

Sympathetic stimulation

increases heart rate and

contractility

Increase in

Cardiac

Contractility

or

Increase in

Heart Rate

Cardiac

Output

Parasympathetic stimulation

decreases heart rate

Atrial Pressure (Preload)

Family of Ventricular Function Curves
ventricular function curve24
Ventricular Function Curve

Pulmonary Congestion

Normal

OUTPUT(BP, CO, SV, CI, SWI)

Hypoperfusion

Hypoperfusion & Pulmonary Congestion

PRELOAD(LVEDV, LVEDP, LAP, PCWP)

ventricular function curve25
Ventricular Function Curve

Pulmonary Congestion

Normal

OUTPUT(BP, CO, SV, CI, SWI)

Hypoperfusion

Hypoperfusion & Pulmonary Congestion

PRELOAD(LVEDV, LVEDP, LAP, PCWP)

slide27

Normal LV Function

LV Failure - Cardiomyopathy

Radionuclear Imaging

ventricular function curve31
Ventricular Function Curve

Increased CO

Decreased afterload

Decreased volume

OUTPUT(BP, CO, SV, CI, SWI)

Decreased CO

Increased afterload

Increased volume

PRELOAD(LVEDV, LVEDP, LAP, PCWP)

ventricular function curve32
Ventricular Function Curve

Diuretics – decrease volume & pressure but no increase in output

OUTPUT(BP, CO, SV, CI, SWI)

A

B

PRELOAD(LVEDV, LVEDP, LAP, PCWP)

ventricular function curve33
Ventricular Function Curve

Nitroprusside – afterload reduced, pressure decreased, output increased

OUTPUT(BP, CO, SV, CI, SWI)

PRELOAD(LVEDV, LVEDP, LAP, PCWP)

ventricular function curve34
Ventricular Function Curve

NTG/Phentolamine – afterload reduced, some decrease in pressure, output increased

OUTPUT(BP, CO, SV, CI, SWI)

PRELOAD(LVEDV, LVEDP, LAP, PCWP)

ventricular function curve35
Ventricular Function Curve

Dig or Dopamine – improved contractility, little decrease in pressure, increased CO

OUTPUT(BP, CO, SV, CI, SWI)

PRELOAD(LVEDV, LVEDP, LAP, PCWP)

ventricular function curve36
Ventricular Function Curve

Amrione – significant increase in CO, significant increase in pressure

OUTPUT(BP, CO, SV, CI, SWI)

PRELOAD(LVEDV, LVEDP, LAP, PCWP)

ventricular function curve37
Ventricular Function Curve

Nitro & Dopamine/Dobutamine – increased intropy, output and pressure

OUTPUT(BP, CO, SV, CI, SWI)

PRELOAD(LVEDV, LVEDP, LAP, PCWP)