Left Ventricular Function Frank-Starling Principle Left Ventricular Failure

1. Left Ventricular FunctionFrank-Starling PrincipleLeft Ventricular Failure Jeffrey Groom, MS, CRNA, ARNPAssociate Professor Anesthesiology Nursing Program Florida International University - Miami, Florida

2. Volume (Preload) Ventricular Output Cardiac Output Atrial Input Right or Left Heart Concept of Ventricular Function Curve

3. Ventricular Function Curve OUTPUT(BP, CO, SV, CI, SWI) VOLUME(LVEDV, LVEDP, LAP, PCWP)

4. Cardiac Output Right Ventricle Left Ventricle Normal CO 5000 ml/min 0 3 Atrial Pressure (Preload) Normal RAP Normal LAP Right and Left Ventricular Function Curves Right CO = Left CO

5. Ventricular Function Curve OUTPUT(BP, CO, SV, CI, SWI) PRELOAD(LVEDV, LVEDP, LAP, PCWP)

6. Left Ventricular Function

7. Ejection Systolic Curve LV Pressure IVC Diastolic Curve SV IVR LV Volume ESV EDV Filling LV Pressure-Volume Loop

8. LV Function and PV Loop

9. Frank-Starling Principle Relationship between cardiac output and left ventricular end-diastolic volume is dictated by the Frank-Starling Principle.

10. Maximum Capacity To Produce SV Stroke Volume Normal Range: SV increases with EDV End-Diastolic Volume Mechanism: Length-Force Relations of Muscle Contraction Frank-Starling’s Law of the Heart

11. Systolic Curve LV Pressure SV2 Diastolic Curve SV1 LV Volume ESV EDV1 EDV2 LV Pressure-Volume Loop andFrank-Starling’s Law EDV2 > EDV1 SV2 > SV1

12. LV Pressure-Volume Loop andFrank-Starling’s Law

13. At a given EDV, SV increases With cardiac contractility High Stroke Volume Increase in Cardiac Contractility Low Preload (End-Diastolic Volume) Family of Frank-Starling Curves

14. Determinants of Preload

15. Venous Return and Preload

16. Increase in Cardiac Contractility or Increase in Heart Rate Cardiac Output Right Atrial Pressure Family of Cardiac Function Curves

17. Sympathetic stimulation increases heart rate and contractility Increase in Cardiac Contractility or Increase in Heart Rate Cardiac Output Parasympathetic stimulation decreases heart rate Atrial Pressure (Preload) Family of Ventricular Function Curves

18. Effects of Intropy (Contractility)

19. Myocardial Contractility

20. Factors Regulating Intropy

21. Afterload and LV Function

22. Afterload and LV Function

23. Cardiac Function Curves

24. Ventricular Function Curve Pulmonary Congestion Normal OUTPUT(BP, CO, SV, CI, SWI) Hypoperfusion Hypoperfusion & Pulmonary Congestion PRELOAD(LVEDV, LVEDP, LAP, PCWP)

25. Ventricular Function Curve Pulmonary Congestion Normal OUTPUT(BP, CO, SV, CI, SWI) Hypoperfusion Hypoperfusion & Pulmonary Congestion PRELOAD(LVEDV, LVEDP, LAP, PCWP)

26. Left Ventricular Function

27. Normal LV Function LV Failure - Cardiomyopathy Radionuclear Imaging

28. Pathophysiology of LV Failure

29. LV Failure and Systolic Dysfunction

30. LV Failure and Diastolic Dysfunction

31. 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)

32. 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)

33. Ventricular Function Curve Nitroprusside – afterload reduced, pressure decreased, output increased OUTPUT(BP, CO, SV, CI, SWI) PRELOAD(LVEDV, LVEDP, LAP, PCWP)

34. Ventricular Function Curve NTG/Phentolamine – afterload reduced, some decrease in pressure, output increased OUTPUT(BP, CO, SV, CI, SWI) PRELOAD(LVEDV, LVEDP, LAP, PCWP)

35. 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)

36. Ventricular Function Curve Amrione – significant increase in CO, significant increase in pressure OUTPUT(BP, CO, SV, CI, SWI) PRELOAD(LVEDV, LVEDP, LAP, PCWP)

37. Ventricular Function Curve Nitro & Dopamine/Dobutamine – increased intropy, output and pressure OUTPUT(BP, CO, SV, CI, SWI) PRELOAD(LVEDV, LVEDP, LAP, PCWP)