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Afterload 15/11/10 Part I Notes = left ventricular wall tension required to overcome resistance to ejection (impedance to ejection of blood from the heart into the arterial circulation) - developed as ventricular muscle fibres shorten during isovolumetric contraction & ejection phases of systole DETERMINED BY - Ventricular size Ventricular volume Chamber radius Wall thickness SVR Aortic compliance MANIPULATION IN ICU - optimal fluid therapy to ensure adequate ventricular size, volume and radius (diastolic volume) - vasopressors: increase SVR - vasodilators: decrease SVR - IABP: decreases afterload - replacement of aortic valve (emergently) Jeremy Fernando (2010)