An LV pressure–volume loop is shown in Figure below (ESPVR, end-systolic pressure–volume relation)
Label 1, 2, 3, and 4.
An LV pressure–volume loop.
a.= 1. Mitral valve opening
b.= 2. End diastole
c.= 3. Aortic valve opening
d.= 4. End systole
A 57-year-old man with a history of CHF presents with acute pulmonary edema. His BP is 110/60 mmHg with an HR of 92 bpm. His examination is consistent with heart failure. His hemodynamics are as follows: PA pressure, 62/27 mmHg; PCWP, 12 mmHg; cardiac output, 1.8 L/min/m2 ; and SVR, 1,968 dyne/s/cm5 .
Which way should the LV pressure–volume loop be shifted?
Up. The response of the LV to increased afterload is to shift the loop up. Increased preload would shift the loop to the right.
Figure below is a schematic illustration of carotid pulse.
Match the diagnosis with the pulse.
Normal. The initial peak of the carotid puse waveform reflects the ejection of the blood from the LV into the aorta before it goes into the periphery. After the pressure peaks, it begins a decline as ejection slows and blood continues to flow to the periphery. There is a reversal of blood flow from the compliant central arteries back toward the ventricle. With this reversal of flow, the aortic valves close. A notch on the descending limb of the aortic pressure curve is associated with this transient reversal of blood flow. The smaller secondary positive wave is attributed to the elastic recoil of the aorta and aortic valve.
Aortic stenosis. Pulsus parvus et tardus which is characteristic of aortic stenosis. Small and delayed carotid pulse.
Aortic regurgitation. Pulsus bisferiens or bifid arterial pulse.
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