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16-September-2008 16:15:16 - Afterload Ventricular systole. Red arrow is path from left ventricle to aorta. Afterload is largely dependent upon aortic pressure. Ventricular systole. Red arrow is path from left ventricle to aorta. Afterload is largely dependent upon aortic pressure. In cardiac physiology, afterload is used to mean the tension produced by a chamber of the heart in order to contract. If the chamber is not mentioned, it is usually assumed to be the left ventricle. However, the strict definition of the term relates to the properties of a single cardiac myocyte. It is therefore only of direct relevance in the laboratory; in the clinic, the term end-systolic pressure is usually more appropriate, although not equivalent. Afterload can also be described as the pressure that the chamber of the heart has to generate in order to eject blood out of the chamber, and thus is a consequence of the arterial pressure, since the pressure in the ventricle must be greater than the systemic pressure in order to open the aortic valve. Everything else held equal, as afterload increases, cardiac output decreases. Pathology Disease processes that increase the left ventricular afterload include increased blood pressure and aortic valve disease. Hypertension Increased blood pressure increases the left ventricular afterload because the left ventricle has to work harder to eject blood into the aorta. This is because the aortic valve won't open until the pressure generated in the left ventricle is higher than the elevated blood pressure. Aortic stenosis increases the afterload because the left ventricle has to overcome the pressure gradient caused by the stenotic aortic valve in addition to the blood pressure in order to eject blood into the aorta. For instance, if the blood pressure is 120/80, and the aortic valve stenosis creates a trans-valvular gradient of 30 mmHg, the left ventricle has to generate a pressure of 110 mmHg in order to open the aortic valve and eject blood into the aorta. Aortic insufficiency increases afterload because a percentage of the blood that is ejected forward regurgitates back through the diseased aortic valve. This leads to elevated systolic blood pressure. The diastolic blood pressure would fall, due to regurgitation. This would result in an increase pulse pressure. Mitral regurgitation decreases the afterload. During ventricular systole, the blood can regurgitate through the diseased mitral valve as well as be ejected through the aortic valve. This means that the left ventricle has to work less to eject blood, causing a decreased afterload. Afterload is largely dependent upon aortic pressure. See also Preload Cardiac output External links afterload at eMedicine Dictionary Overview at cvphysiology.com v d e Cardiovascular system, physiology: cardiovascular physiology Volumes Preload - Afterload - End-systolic volume - End-diastolic volume - Frank-Starling law of the heart Interactions Cardiac output - Cardiac cycle - Wiggers diagram - Pressure volume diagram Tropism Chronotropic - Dromotropic - Inotropic - Batmotropic - Lusitropic Hemodynamics Baroreflex - Kinin-kallikrein system - Renin-angiotensin system - Vasoconstrictors - Vasodilators - Compliance - Vascular resistance Other Electrical conduction system of the heart Cardiac action potential - Heart sounds Gallop rhythm, Third heart sound, Fourth heart sound - Pulse - Blood flow Retrieved from http://en..org/wiki/Afterload Categories: Cardiology Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Polski This page was last modified on 15 May 2008, at 18:26
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