Skip to main content
SpringerLink
Log in

Preload

  • Chapter
  • First Online:
Cardiovascular Hemodynamics

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

The four major determinants of cardiac output are cardiac preload, myocardial contractility, heart rate, and afterload. Of these four elements, preload is the primary determinant. Cardiac preload is a semi-quantitative composite assessment that is variously described in different cardiovascular physiology texts and articles as end-diastolic myocardial fiber tension, end-diastolic myocardial fiber length, ventricular end-diastolic volume, and ventricular end-diastolic filling pressure [1]. There is a general recognition that preload is not synonymous with any one of these measurable parameters, but is rather a physiological concept that encompasses all of the factors that contribute to passive ventricular wall stress at the end of diastole.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Norton JM. Towards consistent definitions for preload and afterload. Adv Physiol Educ. 2001;25:53–61.

    PubMed  CAS  Google Scholar 

  2. Mohrman DE, Lois JH. Cardiovascular physiology, Lange physiology series. 5th ed. London: McGraw Hill; 2003.

    Google Scholar 

  3. Schuster M, Nave H, Piepenbrock S, Pabst R, Panning B. The carina as a landmark in central venous catheter placement. Br J Anaesth. 2000;85:192–4.

    Article  PubMed  CAS  Google Scholar 

  4. Daily EK, Schoroeder JS. Techniques in bedside hemodynamic monitoring. 2nd ed. St. Louis: Mosby; 1994.

    Google Scholar 

  5. Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A, McGoon M, Naeije R, Olschewski H, Oudiz RJ, Torbicki A. Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2009;54(1 Suppl):S55–66.

    Article  PubMed  Google Scholar 

  6. Ross Jr J, Braunwald E. Studies on Starling’s Law of the Heart: IX. The effect of impeding venous return on performance of the normal and failing human left ventricle. Circulation. 1964;30:719–27.

    Article  PubMed  Google Scholar 

  7. Rothe CF. Physiology of venous return. An unappreciated boost to the heart. Arch Intern Med. 1986;146(5):977–82.

    Article  PubMed  CAS  Google Scholar 

  8. Tyberg JV. Venous modulation of ventricular preload. Am Heart J. 1992;123(4 Pt 1):1098–104.

    Article  PubMed  CAS  Google Scholar 

  9. Johnson LR. Essential medical physiology. 3rd ed. San Diego: Academic; 2003.

    Google Scholar 

  10. Peters J, Fraser C, Stuart RS, Baumgartner W, Robotham JL. Negative intrathoracic pressure decreases independently left ventricular filling and emptying. Am J Physiol. 1989;257(1 Pt 2):H120–31.

    PubMed  CAS  Google Scholar 

  11. Forrester JS, Diamond G, McHugh TJ, Swan HJ. Filling pressures in the right and left sides of the heart in acute myocardial infarction. A reappraisal of central-venous-pressure monitoring. N Engl J Med. 1971;285(4):190–3.

    Article  PubMed  CAS  Google Scholar 

  12. Ahrens TS, Taylor LA. Hemodynamic waveform analysis. Philadelphia: WB Saunders; 1992.

    Google Scholar 

  13. Warren SE, Dennish G. Vasodilator treatment for acute and chronic heart failure. Br Heart J. 1978;40:1059–60.

    Article  PubMed  CAS  Google Scholar 

  14. Yamamuro A, Yoshida K, Hozumi T, Akasaka T, Takagi T, Kaji S, Kawamoto T, Yoshikawa J. Noninvasive evaluation of pulmonary capillary wedge pressure in patients with acute myocardial infarction by deceleration time of pulmonary venous flow velocity in diastole. J Am Coll Cardiol. 1999;34:90–4.

    Article  PubMed  CAS  Google Scholar 

  15. Rahimtoola SH, Loeb HS, Ehsani A, Sinno MZ, Chuquimia R, Lal R, Rosen KM, Gunnar RM. Relationship of pulmonary artery to left ventricular diastolic pressures in acute myocardial infarction. Circulation. 1972;46:283–90.

    Article  PubMed  CAS  Google Scholar 

  16. Zile MR, Gaasch WH, Carroll JD, Feldman MD, Aurigemma GP, Schaer GL, Ghali JK, Liebson PR. Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation. 2001;104:779–82.

    Article  PubMed  CAS  Google Scholar 

  17. Katz AM. Ernest Henry Starling, his predecessors, and the “law of the heart.” Circulation. 2002;106:2986–92.

    Article  PubMed  Google Scholar 

  18. Starling EH. The Linacre lecture on the law of the heart. In: Chapman CB, Mitchell JH, editors. Starling on the heart. London: Dawsons of Pall Mall; 1965. p. 119–47.

    Google Scholar 

  19. Ross J Jr, Franklin D, Sasayama S. Preload, afterload, and the role of afterload mismatch in the descending limb of cardiac function. Eur J Cardiol. 1976;4 Suppl:77–86.

    Google Scholar 

  20. Julian FJ, Morgan DL. The effect on tension of non-uniform distribution of length changes applied to frog muscle fibres. J Physiol. 1979;293:379–92.

    PubMed  CAS  Google Scholar 

  21. Fuchs F, Smith SH. Calcium, cross-bridges, and the Frank-Starling relationship. News Physiol Sci. 2001;16:5–10.

    PubMed  CAS  Google Scholar 

  22. Fuster V, Walsh R. Hurst’s the heart, vol. 1. 13th ed. McGraw Hill: Harrington; 2011.

    Google Scholar 

  23. Plnsky PR. Hemodynamic evaluation and monitoring in the ICU. Chest. 2007;132:2020–9.

    Article  Google Scholar 

  24. Morris AH, Chapman RH, Gardner RM. Frequency of technical problems encountered in the measurement of pulmonary artery wedge pressure. Crit Care Med. 1984;12:164–70.

    Article  PubMed  CAS  Google Scholar 

  25. Iberti TJ, Fischer EP, Leibowitz AB, Panacek EA, Silverstein JH, Albertson TE. A multicenter study of physicians’ knowledge of the pulmonary artery catheter. Pulmonary Artery Catheter Study Group. JAMA. 1990;264:2928–32.

    Article  PubMed  CAS  Google Scholar 

  26. Jellinek H, Krafft P, Fitzgerald RD, Schwarz S, Pinsky MR. Right atrial pressure predicts hemodynamic response to apneic positive airway pressure. Crit Care Med. 2000;28(3): 672–8.

    Article  PubMed  CAS  Google Scholar 

  27. Pinsky MR, Brochard L, Mancebo J. Applied physiology in intensive care medicine. Berlin: Springer; 2006.

    Google Scholar 

  28. Wong DH, O’Connor D, Tremper KK, Zaccari J, Thompson P, Hill D. Changes in cardiac output after acute blood loss and position change in man. Crit Care Med. 1989;17:979–83.

    Article  PubMed  CAS  Google Scholar 

  29. Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34(5):1402–7.

    Article  PubMed  Google Scholar 

  30. Cheatham ML, Nelson LD, Chang MC, Safcsak K. Right ventricular end-diastolic volume index as a predictor of preload status in patients on positive end-expiratory pressure. Crit Care Med. 1998;26(11):1801–6.

    Article  PubMed  CAS  Google Scholar 

  31. Diebel L, Wilson RF, Heins J, Larky H, Warsow K, Wilson S. End-diastolic volume versus pulmonary artery wedge pressure in evaluating cardiac preload in trauma patients. J Trauma. 1994;37(6):950–5.

    Article  PubMed  CAS  Google Scholar 

  32. Kraut EJ, Owings JT, Anderson JT, Hanowell L, Moore P. Right ventricular volumes overestimate left ventricular preload in critically ill patients. J Trauma. 1997;42(5):839–46.

    Article  PubMed  CAS  Google Scholar 

  33. Tousignant CP, Walsh F, Mazer CD. TEE and preload assessment in critically ill patients. Anesthesiol Analg. 2000;90:351–5.

    CAS  Google Scholar 

  34. Loubieres Y, Vieillard-Baron A, Beauchet A, Fourme T, Page B, Jardin F. Echocardiographic evaluation of left ventricular function in critically ill patients: dynamic loading challenge using medical antishock trousers. Chest. 2000;118:1718–23.

    Article  PubMed  CAS  Google Scholar 

  35. Hoeft A, Schorn B, Weyland A, Scholz M, Buhre W, Stepanek E, Allen SJ, Sonntag H. Bedside assessment of intravascular volume status in patients undergoing coronary bypass surgery. Anesthesiology. 1994;81:76–86.

    Article  PubMed  CAS  Google Scholar 

  36. Buhre W, Buhre K, Kazmaier S, Sonntag H, Weylandà A. Assessment of cardiac preload by indicator dilution and transoesophageal echocardiography. Eur J Anaesthesiol. 2001;18: 662–7.

    PubMed  CAS  Google Scholar 

  37. Sakka SG, Meier-Hellmann A. Evaluation of cardiac output and cardiac preload. In: Vincent JL, editor. Yearbook of intensive care and emergency medicine. Berlin: Springer; 2000. p. 671–9.

    Google Scholar 

  38. Barash PG, Cullen BF, Stoelting RK, editors. Clinical anesthesia. Philadelphia: Lippincott Williams & Wilkins; 2009.

    Google Scholar 

  39. McKendry M, McGloin H, Saberi D, Caudwell L, Brady AR, Singer M. Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. BMJ. 2004;329:258–61.

    Article  PubMed  Google Scholar 

  40. Marik ME. Pulmonary artery catheterization and esophageal Doppler monitoring in the ICU. Chest. 1999;116:1085–91.

    Article  PubMed  CAS  Google Scholar 

Suggested Reading

  • Daily EK, Schoroeder JS. Techniques in bedside hemodynamic monitoring. 5th ed. St. Louis: Mosby; 1994.

    Google Scholar 

  • Ahrens TS, Taylor LA. Hemodynamic waveform analysis. Philadelphia: WB Saunders; 1992. Chapters 2 and 3.

    Google Scholar 

  • Fuster V, Walsh R. Hurst’s the heart, vol. 1. 13th ed. McGraw Hill: Harrington; 2011. Part 2, Chapters 5.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiovascular Medicine Fellow, Heart and Vascular Institute, Cleveland Clinic, Ohio, USA

    Amanda R. Vest

  2. The Cleveland Clinic, Cleveland, OH, USA

    Frederick Heupler Jr. MD

Authors
  1. Amanda R. Vest
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frederick Heupler Jr. MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amanda R. Vest .

Editor information

Editors and Affiliations

  1. Cardiovascular Medicine, The Cleveland Clinic, Cleveland, Ohio, USA

    Saif Anwaruddin

  2. Cardiovascular Medicine, The Cleveland Clinic, Chagrin Falls, Ohio, USA

    Joseph M. Martin

  3. Cardiovascular Medicine, The Cleveland Clinic, Cleveland, Ohio, USA

    John C. Stephens

  4. Western Reserve Heart Care, Hudson, Ohio, USA

    Arman T. Askari

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Vest, A.R., Heupler, F. (2013). Preload. In: Anwaruddin, S., Martin, J., Stephens, J., Askari, A. (eds) Cardiovascular Hemodynamics. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-195-0_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-195-0_1

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-194-3

  • Online ISBN: 978-1-60761-195-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation