Draw and label a left ventricular pressure volume loop in a normal adult. List the information that can be obtained from this loop.

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College Answer

Candidates were expected to draw and label a diagram showing the relationship between
pressure and volume during the different phases of the left ventricular contraction and
relaxation (or systole and diastole)
Good answers to this question consisted of a well-labelled graph with appropriate scale on
both x and y-axes showing all the important events during systole and diastole of the left
The common omissions were rapid and slow ejection phase during systole, when aortic valve
closes, stroke volume, ejection fraction, end-systolic pressure volume line showing the
contractility of the left ventricle.
Some candidates appeared to have confusion about which line shows contractility and which
line shows left ventricular after load.
Syllabus C1c
Reference: Kam 1st edition 115-121
Guyton 11th edition 110


Looking at that list of common omissions, one rapidly comes to the conclusion that the college wanted all the things. That makes for a messy diagram, which - in the wrong hands- would violate every rule of graphic design, and fail at the basic premise of being an explanatory schematic representation. However, if that's what they wanted...


The following information can be obtained from this monstrosity: 

  • Volumes:
    • End-diastolic volume (where the mitral valve opens)
    • End-systolic volume (where the aortic valve closes)
    • Stroke volume (the difference between the end-diastolic and end-systolic volumes)
    • Ejection fraction, which is the ratio of stroke volume to end-diastolic volume
  • Pressures:
    • Systolic blood pressure (peak of the curve)
    • Diastolic blood pressure (where the aortic valve opens)
    • End-systolic blood pressure (where the aortic valve closes)
  • Pressure-volume relationships:
    • Systolic ejection, which has fast and slow phases
    • Diastolic filling
    • Isovolumetric contraction and relaxation
    • The end-diastolic pressure-volume relationship (EDPVR), which describes ventricular elastance
    • The end-systolic pressure-volume relationship (ESPVR), which describes contractility
    • The effective arterial elastance line which connects the point of end-diastolic pressure and volume to the point of end-systolic volume, and which is an approximation of afterload
  • Areas:
    • Total mechanical energy (stroke work),  which consists of:
      • Stroke work, which is the total area of the P-V loop 
      • Stored "potential" mechanical energy (in the LV wall), which is the area under the ESPVR line.


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