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Frank-Starling relation in heart failure. Idealized family of Frank-Starling curves produced by worsening ventricular function in heart failure. In ventricles
with normal cardiac performance, there is a steep and positive relationship between increased cardiac filling pressures (as estimated from the left
ventricular end-diastolic or pulmonary capillary wedge pressure) and increased stroke volume or cardiac output (top curve). By comparison, during
progression from mild to severe myocardial dysfunction, this relationship is right shifted (ie, a higher filling pressure is required to achieve the same cardiac
output) and flattened so that continued increases in left heart filling pressures lead to minimal increases in cardiac output at the possible expense of
pulmonary edema. The onset of mild heart failure results in an initial reduction in cardiac function (from point A to point B), a change that can be
Source: PATHOPHYSIOLOGYOF HEART FAILURE, Hurst's The Heart, 14e
normalized, at least at rest, by raising the left ventricular end-diastolic pressure (LVEDP) via fluid retention (point C). Diuretic therapy reduces left
Citation:
FusteratV,the
Harrington
Naruladecreased
J, Eapen ZJ.
Hurst's
The (moving
Heart, 14e;
2017
Available
at: http://mhmedical.com/
Accessed: May
06,
ventricular filling
pressure
expense RA,
of mildly
cardiac
output
from
point
C to point
B). By comparison, normalization
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2017
volume is not attainable in severe heart failure (bottom curve). Reproduced with permission from: Cohn JN. Cardiac remodeling: Basic aspects. In:
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