Left Ventricular Function FrankStarling Principle Left Ventricular Failure

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Left Ventricular FunctionFrank-Starling
PrincipleLeft Ventricular Failure

• Jeffrey Groom, MS, CRNA, ARNPAssociate Professor
  Anesthesiology Nursing Program Florida
  International University - Miami, Florida

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Concept of Ventricular Function Curve
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Ventricular Function Curve
OUTPUT(BP, CO, SV, CI, SWI)
VOLUME(LVEDV, LVEDP, LAP, PCWP)
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Right and Left Ventricular Function Curves
Right CO Left CO
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Ventricular Function Curve
OUTPUT(BP, CO, SV, CI, SWI)
PRELOAD(LVEDV, LVEDP, LAP, PCWP)
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Left Ventricular Function
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LV Pressure-Volume Loop
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LV Function and PV Loop
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Frank-Starling Principle
Relationship between cardiac output and left
ventricular end-diastolic volume is dictated by
the Frank-Starling Principle.
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Frank-Starlings Law of the Heart
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LV Pressure-Volume Loop andFrank-Starlings Law
EDV2 gt EDV1 SV2 gt SV1
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LV Pressure-Volume Loop andFrank-Starlings Law
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Family of Frank-Starling Curves
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Determinants of Preload
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Venous Return and Preload
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Family of Cardiac Function Curves
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Family of Ventricular Function Curves
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Effects of Intropy (Contractility)
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Myocardial Contractility
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Factors Regulating Intropy
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Afterload and LV Function
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Afterload and LV Function
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Cardiac Function Curves
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Ventricular Function Curve
Pulmonary Congestion
Normal
OUTPUT(BP, CO, SV, CI, SWI)
Hypoperfusion
Hypoperfusion Pulmonary Congestion
PRELOAD(LVEDV, LVEDP, LAP, PCWP)
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Ventricular Function Curve
Pulmonary Congestion
Normal
OUTPUT(BP, CO, SV, CI, SWI)
Hypoperfusion
Hypoperfusion Pulmonary Congestion
PRELOAD(LVEDV, LVEDP, LAP, PCWP)
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Left Ventricular Function
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Normal LV Function
LV Failure - Cardiomyopathy
Radionuclear Imaging
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Pathophysiology of LV Failure
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LV Failure and Systolic Dysfunction
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LV Failure and Diastolic Dysfunction
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Ventricular Function Curve
Increased CO
Decreased afterload
Decreased volume
OUTPUT(BP, CO, SV, CI, SWI)
Decreased CO
Increased afterload
Increased volume
PRELOAD(LVEDV, LVEDP, LAP, PCWP)
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Ventricular Function Curve
Diuretics decrease volume pressure but no
increase in output
OUTPUT(BP, CO, SV, CI, SWI)
A
B
PRELOAD(LVEDV, LVEDP, LAP, PCWP)
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Ventricular Function Curve
Nitroprusside afterload reduced, pressure
decreased, output increased
OUTPUT(BP, CO, SV, CI, SWI)
PRELOAD(LVEDV, LVEDP, LAP, PCWP)
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Ventricular Function Curve
NTG/Phentolamine afterload reduced, some
decrease in pressure, output increased
OUTPUT(BP, CO, SV, CI, SWI)
PRELOAD(LVEDV, LVEDP, LAP, PCWP)
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Ventricular Function Curve
Dig or Dopamine improved contractility, little
decrease in pressure, increased CO
OUTPUT(BP, CO, SV, CI, SWI)
PRELOAD(LVEDV, LVEDP, LAP, PCWP)
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Ventricular Function Curve
Amrione significant increase in CO, significant
increase in pressure
OUTPUT(BP, CO, SV, CI, SWI)
PRELOAD(LVEDV, LVEDP, LAP, PCWP)
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Ventricular Function Curve
Nitro Dopamine/Dobutamine increased intropy,
output and pressure
OUTPUT(BP, CO, SV, CI, SWI)
PRELOAD(LVEDV, LVEDP, LAP, PCWP)