Changes in pressure-volume loops

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Changes in pressure-volume loops

Cardiovascular system


Changes in pressure-volume loops


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Changes in pressure-volume loops

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A 37-year-old woman presents for evaluation of fatigue and dyspnea. These symptoms are exacerbated by exertion. She immigrated from Cambodia 15 years ago. Past medical history is notable for seasonal allergies and an episode of severe pharyngitis as a child. Temperature is 37.0°C (98.6°F), blood pressure is 127/81 mmHg, and pulse is 72/min. On physical examination, an opening snap is heard after the S2 heart sound. This murmur is best heard over the 5th intercostal space at the midclavicular line. Pulmonary and abdominal examinations are unremarkable. This patient will most likely have which of the following pressure-volume loops?  

*The dark blue loop represents that of a healthy individual and is meant to serve as a reference.  


Pressure- volume loops are graphs, where the pressure inside the left ventricle is on the y axis and the volume of the left ventricle is on the x axis. Each loop represents one cardiac cycle, including both ventricular systole and diastole, or more simply, one heartbeat.

The lower right hand corner is the end-diastolic point, and it’s the point in the cardiac cycle when diastole is over. Αt this point, the mitral valve is closed and the left ventricle is filled with the maximum volume of blood, known as end-diastolic volume. After that, the left ventricle contracts, and systole begins. This makes the pressure shoot up, but since both mitral and aortic valves are closed, the left ventricular volume doesn’t change. This phase is isovolumetric contraction. Eventually the pressure inside the left ventricle exceeds aortic pressure, forcing the aortic valve to pop open, and that starts the ejection phase. Blood leaves the left ventricle and goes into the aorta, decreasing left ventricular volume. The left ventricle continues to contract, so ventricular pressure keeps rises further, but then falls slightly and finally the aortic valve shuts when aortic pressure exceeds the left ventricular pressure. That point, called the end-systolic point, marks the end of systole. At this point, left ventricular pressure is called end-systolic pressure, and left ventricular volume is called end-systolic volume. The difference between end-diastolic volume and end-systolic volume, is the stroke volume. After that, the left ventricular muscle starts relaxing, so left ventricular pressure falls. However, all valves are closed, so the volume remains constant. This phase is isovolumetric relaxation. Eventually, the pressure drops below left atrial pressure, and that allows the mitral valve to open and blood to flow from the left atrium flows into the left ventricle. As the left ventricle fills with blood, its volume rises back to its end-diastolic volume, and the pressure increases only slightly. This relaxation phase continues until the mitral valve closes, letting the loop start all over again.


Pressure-volume loops are graphs used to study the effects of changing preload, afterload, and contractility of the heart. The pressure inside the left ventricle is plotted on the y-axis, whereas its volume is on the x-axis. A loop presents one cardiac cycle or one heartbeat comprising diastole and systole. When preload and contractility increase, it leads to an increase in the size of the pressure-volume loop. When the afterload increases, it leads to an increase in pressure and a decrease in stroke volume. This helps to keep the stroke work stable.


  1. "Medical Physiology" Elsevier (2016)
  2. "Physiology" Elsevier (2017)
  3. "Human Anatomy & Physiology" Pearson (2018)
  4. "Principles of Anatomy and Physiology" Wiley (2014)
  6. "Stroke volume--pulse pressure relationships in borderline hypertension: a possible indicator of decreased arterial compliance" J Hypertens Suppl (1984)

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