Question 12(p.2)

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.


Bastos, Marcelo B., et al. "Invasive left ventricle pressure–volume analysis: overview and practical clinical implications." European Heart Journal 41.12 (2020): 1286-1297.

Sagawa, Kiichi. "The ventricular pressure-volume diagram revisited." Circulation Research 43.5 (1978): 677-687.

Otto, Frank. "Die grundform des arteriellen pulses." Zeitung fur Biologie 37 (1899): 483-586.

Middeke, Martin. "The pioneer in hemodynamics and pulse-wave analysis, Otto Frank." Journal of the American Society of Hypertension 10.4 (2016): 290-296.

Glantz, St A., and W. W. Parmley. "Factors which affect the diastolic pressure-volume curve." Circulation Research 42.2 (1978): 171-180.

Pasipoularides, Ares. "Right and left ventricular diastolic pressure–volume relations: a comprehensive review." Journal of cardiovascular translational research 6.2 (2013): 239-252.

Pak, Peter H., et al. "Marked discordance between dynamic and passive diastolic pressure-volume relations in idiopathic hypertrophic cardiomyopathy." Circulation 94.1 (1996): 52-60.

Zile, Michael R., Catalin F. Baicu, and William H. Gaasch. "Diastolic heart failure—abnormalities in active relaxation and passive stiffness of the left ventricle." New England Journal of Medicine 350.19 (2004): 1953-1959.

Sunagawa, Kenji, et al. "Left ventricular interaction with arterial load studied in isolated canine ventricle.American Journal of Physiology-Heart and Circulatory Physiology 245.5 (1983): H773-H780.

Kelly, Raymond P., et al. "Effective arterial elastance as index of arterial vascular load in humans." Circulation 86.2 (1992): 513-521.

Chantler, Paul D., Edward G. Lakatta, and Samer S. Najjar. "Arterial-ventricular coupling: mechanistic insights into cardiovascular performance at rest and during exercise." Journal of applied physiology 105.4 (2008): 1342-1351.

Jozwiak, Mathieu, et al. "Validation and critical evaluation of the effective arterial elastance in critically ill patients." Critical care medicine 47.4 (2019): e317-e324.

Kass, David A., et al. "Determination of left ventricular end-systolic pressure-volume relationships by the conductance (volume) catheter technique." Circulation 73.3 (1986): 586-595.

Walley, Keith R. "Left ventricular function: time-varying elastance and left ventricular aortic coupling." Critical care 20.1 (2016): 270.

Khalafbeigui, F., H. Suga, and K. Sagawa. "Left ventricular systolic pressure-volume area correlates with oxygen consumption." American Journal of Physiology-Heart and Circulatory Physiology 237.5 (1979): H566-H569.

Suga, Hiroyuki, Takakazu Hayashi, and Machiko Shirahata. "Ventricular systolic pressure-volume area as predictor of cardiac oxygen consumption." American Journal of Physiology-Heart and Circulatory Physiology 240.1 (1981): H39-H44.

Suga, Hiroyuki. "External mechanical work from relaxing ventricle.American Journal of Physiology-Heart and Circulatory Physiology 236.3 (1979): H494-H497.