Evaluation of LV Failure

Question 1

Compensated LV diastolic or systolic dysfunction is characterized by a normal or high _________ (>16 mmHg), ________ LV diastolic pressure before A wave and a ___________ mean PCWP at rest

Decompensated LV diastolic or systolic failure is characterized by a _________ LV diastolic pressure __________ diastole, _________ mean LA pressure and PCWP , V wave is sometimes prominent, and there is a ___________ PCWP-LV pressure gradient in early diastole

Answer 1

1. LVEDP, normal, normal (increase LVEDP after LV A wave)
2. High, throughout diastole, high, high

Question 2

True or False

The failing LV is exquisitely sensitive to afterload changes

Answer 2

True

Cardiac output improves with afterload reduction and with diuresis
CO is not reduced with preload reduction, particularly that the CO-LV volume curve is at a flat part

Question 3

How does diuresis improve CO in decompensated LV failure?

Diuresis reduces RV and LV ______________
Reduced functional ____________ improving forward CO

Answer 3

In case of RV failure, diuresis reduces RV volume and thus reduces the compression of the LV

Diuresis reduces LV volume, which, besides defining preload, is a major determinant of LV wall stress, that is, LV afterload

Diuresis reduces the severity of functional MR and, consequently, improves forward CO

Question 4

The most commonly used index of contractility in clinical practice

Answer 4

Ejection Fraction

EF = stroke volume / end-diastolic volume

EF is highly affected by preload; for similar contractility, EF is smaller if LV size is larger. It is also affected by afterload; an increase in afterload reduces the numerator, stroke volume, and thus EF.

Question 5

___________________ is a hemodynamic parameter of contractility. It measures the steepest rise in pressure on the LV ascent

Answer 5

The maximal pressure rise during isovolumic contraction (dP/ dt max)

dP/dt is also affected by preload, heart rate, and presence of dyssynchrony