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Transcript
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 of stroke 2017 volume is not attainable in severe heart failure (bottom curve). Reproduced with permission from: Cohn JN. Cardiac remodeling: Basic aspects. In: Copyright © 2017 McGraw-Hill Education. rights reserved UpToDate, Post TW (Ed), UpToDate, Waltham, MA. All (Accessed on January 28, 2017.) Copyright ©2017 UpToDate, Inc. For more information visit www.uptodate.com.