Preload (cardiology)

Estimating preload

Though not exactly equivalent to the strict definition of preload, end-diastolic volume is better suited to the clinic. It is relatively straightforward to estimate the volume of a healthy, filled left ventricle by visualizing the 2D cross-section with cardiac ultrasound. This technique is less helpful for estimating right ventricular preload because it is difficult to calculate the volume in an asymmetrical chamber. In cases of rapid heart rate, it can be difficult to capture the moment of maximum fill at the end of diastole, which means the volume may be difficult to measure in children or during tachycardia.

An alternative to estimating the end-diastolic volume of the heart is to measure the end-diastolic pressure. This is possible because pressure and volume are related to one another according to Boyle's law, which can be simplified to

${\displaystyle P\propto \frac{1}{V}}$

The end diastolic pressure of the right ventricle can measured directly with a Swan-Ganz catheter. For the left ventricle, end diastolic pressure is most commonly estimated by taking the pulmonary wedge pressure, which is approximately equal to the pressure in the left atrium when the lungs are healthy. When the heart is healthy the diastolic pressure in the left atrium and left ventricle are equal. When both the heart and lungs are healthy, pulmonary wedge pressure is equal to left ventricle diastolic pressure and can be used as a surrogate for preload. Pulmonary wedge pressure will overestimate left ventricle pressure in people with mitral valve stenosis, pulmonary hypertension and other heart and lung conditions.

Estimation of preload may also be inaccurate in a chronically dilated ventricles because additional new sarcomeres cause the relaxed ventricle to appear enlarged.