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The Frank-Starling curves depicted here relate the loading conditions of the left ventricle (preload—as measured by left ventricular end-diastolic pressure
[LVEDP]) and stroke volume. Stroke volume (SV) is the amount of blood ejected into the aorta by the heart with each beat.
Changes in afterload (vascular resistance), preload (volume delivered to the ventricle to eject), and contractility can all interact to change the stroke
volume. Point A represents a patient with systolic heart failure. The LVEDP of this impaired patient is high and the SV is low compared to that expected in
the normal patient. Reducing the patient's preload moves the patient from point A to points B and C. The SV is relatively unchanged at point B; however,
the LVEDP isSource:
reduced.
This can
occur secondaryand
to the
use ofAnesthesia,
diuretic therapy.
The
lower LVEDP
may reduce symptoms
of fluid overload and congestion.
Chapter
2. Hemodynamics
Cardiac
Cardiac
Anesthesia
and Transesophageal
Echocardiography
However, advancing to point C, SV is further reduced bringing into question the adequacy of tissue oxygen delivery.
Citation: Wasnick JD, Hillel Z, Kramer D, Littwin S, Nicoara A. Cardiac Anesthesia and Transesophageal Echocardiography; 2011 Available at:
Increasing contractility
and decreasing afterload
through
the2017
use of inodilators such as milrinone will move the patient's Starling curve to points (D)
http://mhmedical.com/
Accessed:
May 12,
reflecting an Copyright
increased ©
SV
and
a
lower
LVEDP
thereby
relieving
both symptoms of congestive heart failure and improving tissue oxygen delivery. Note for
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the same LVEDP, the SV is lower in the patient with impaired ventricular function. (From: William J Hoffman, John D Wasnick, eds. Postoperative Critical