, Chapter List
Chapter 1: Left Ventricular Physiology
Chapter 2: Right Ventricular Physiology and the Management of Right Ventricular Failure
Chapter 3: Acute Respiratory Distress Syndrome and Mechanical Ventilation in Patients With
Compromised Cardiac Function
Chapter 4: An Overview of Cardiogenic Shock
Chapter 5: Pharmacology of Commonly Used Medications in Cardiovascular Critical Care
Chapter 6: Pulmonary Artery Catheterization and Its Utility in Cardiovascular Critical Care
Chapter 7: Pulmonary Hypertension
Chapter 8: Coronary Angiography for Noncardiologists
Chapter 9: Myocardial Infarction and Ischemia
Chapter 10: Electrophysiologic Procedures in the Intensive Care Unit
Chapter 11: Valve Disease: Aortic Stenosis and Aortic Insufficiency
Chapter 12: Myocarditis
Chapter 13: Stress Cardiomyopathy
Chapter 14: Evaluation and Management of the Patient With Heart Failure With Reduced
Ejection Fraction in the Intensive Care Unit
Chapter 15: Constrictive Pericarditis and Restrictive Cardiomyopathy
Chapter 16: Congenital Heart Disease in the Adult
Chapter 17: Enhanced Recovery After Surgery
Chapter 18: Cardiopulmonary Bypass for the Intensivist
Chapter 19: Immediate Postoperative Management and Complications in the Cardiac Surgical
Patient
Chapter 20: Postoperative Bleeding
Chapter 21: Postoperative Management of Pulmonary Thromboendarterectomy
Chapter 22: Neurologic Complications After Cardiac Surgery and Procedures
Chapter 23: Intensive Care Unit Management of Patients After Heart and Lung Transplant
Chapter 24: Postcardiotomy Shock
Chapter 25: Critical Care of a Patient After Transcatheter Valve Interventions
Chapter 26: Venovenous Extracorporeal Membrane Oxygenation
Chapter 27: Venoarterial Extracorporeal Membrane Oxygenation
Chapter 28: Percutaneous Ventricular Assist Devices: Left Ventricle / Right Ventricle
Chapter 29: Durable Left Ventricular Assist Devices
Chapter 30: Echocardiography in the Patient on Mechanical Circulatory Support
Chapter 31: Frontiers in Mechanical Circulatory Support: Ventricular Assist Devices for the
Right Ventricle, Adult Congenital, Miniature Ventricular Assist Devices, and Military and
Mobile Extracorporeal Membrane Oxygenation Teams
Chapter 32: Cannulation Strategies
Chapter 33: Transport of Patients on Mechanical Circulatory Support
Chapter 34: Ethics in Mechanical Circulatory Support
,Chapter 1: Left Ventricular Physiology
Context: Mechanics of the left ventricle, including preload, afterload,
contractility, and ejection fraction; effects on cardiac output and systemic
perfusion; relevance in heart failure and cardiogenic shock.
Question 1
A 65-year-old patient in cardiogenic shock has a left ventricular end-diastolic
volume of 150 mL and a normal contractility. Which intervention will most
effectively increase stroke volume according to the Frank-Starling mechanism?
A. Administering a high-dose vasodilator
B. Giving a moderate fluid bolus
C. Initiating high-dose beta-blocker therapy
D. Starting mechanical ventilation with high PEEP
Answer: B
Rationale: Increasing preload via a fluid bolus enhances LV end-diastolic
volume, which stretches myocardial fibers and increases stroke volume via the
Frank-Starling relationship. Vasodilators reduce afterload but do not acutely
increase preload; beta-blockers decrease contractility; high PEEP reduces
venous return, decreasing preload.
Key words: preload, Frank-Starling, stroke volume, cardiogenic shock
Question 2
In a patient with chronic hypertension, the left ventricle develops concentric
hypertrophy. How does this affect afterload and stroke volume?
A. Afterload decreases, stroke volume increases
B. Afterload increases, stroke volume decreases
C. Afterload decreases, stroke volume decreases
D. Afterload increases, stroke volume increases
Answer: B
, Rationale: Concentric hypertrophy increases wall thickness to compensate for
elevated systemic vascular resistance, raising afterload. The stiff ventricle has
reduced compliance, impairing stroke volume despite preserved contractility.
Key words: afterload, LV hypertrophy, stroke volume, compliance
Question 3
A patient with acute myocardial infarction has severely reduced LV
contractility. Which intervention will acutely improve cardiac output?
A. Administration of a negative inotrope
B. Use of an inotropic agent like dobutamine
C. Initiation of beta-blocker therapy
D. Increasing systemic vascular resistance with phenylephrine
Answer: B
Rationale: Dobutamine increases myocardial contractility, enhancing stroke
volume and cardiac output. Negative inotropes worsen output; beta-blockers
reduce contractility acutely; increasing afterload with phenylephrine may
decrease cardiac output in a failing LV.
Key words: contractility, inotrope, cardiac output, acute MI
Question 4
Which parameter best reflects left ventricular contractility independent of
preload and afterload?
A. Stroke volume
B. Ejection fraction
C. End-diastolic volume
D. Systolic blood pressure
Answer: B
Rationale: Ejection fraction (EF) is a relative measure of stroke volume to end-
diastolic volume and reflects contractility independent of absolute preload and
afterload, especially in hemodynamically stable conditions. Stroke volume and
BP are influenced by loading conditions.
Chapter 1: Left Ventricular Physiology
Chapter 2: Right Ventricular Physiology and the Management of Right Ventricular Failure
Chapter 3: Acute Respiratory Distress Syndrome and Mechanical Ventilation in Patients With
Compromised Cardiac Function
Chapter 4: An Overview of Cardiogenic Shock
Chapter 5: Pharmacology of Commonly Used Medications in Cardiovascular Critical Care
Chapter 6: Pulmonary Artery Catheterization and Its Utility in Cardiovascular Critical Care
Chapter 7: Pulmonary Hypertension
Chapter 8: Coronary Angiography for Noncardiologists
Chapter 9: Myocardial Infarction and Ischemia
Chapter 10: Electrophysiologic Procedures in the Intensive Care Unit
Chapter 11: Valve Disease: Aortic Stenosis and Aortic Insufficiency
Chapter 12: Myocarditis
Chapter 13: Stress Cardiomyopathy
Chapter 14: Evaluation and Management of the Patient With Heart Failure With Reduced
Ejection Fraction in the Intensive Care Unit
Chapter 15: Constrictive Pericarditis and Restrictive Cardiomyopathy
Chapter 16: Congenital Heart Disease in the Adult
Chapter 17: Enhanced Recovery After Surgery
Chapter 18: Cardiopulmonary Bypass for the Intensivist
Chapter 19: Immediate Postoperative Management and Complications in the Cardiac Surgical
Patient
Chapter 20: Postoperative Bleeding
Chapter 21: Postoperative Management of Pulmonary Thromboendarterectomy
Chapter 22: Neurologic Complications After Cardiac Surgery and Procedures
Chapter 23: Intensive Care Unit Management of Patients After Heart and Lung Transplant
Chapter 24: Postcardiotomy Shock
Chapter 25: Critical Care of a Patient After Transcatheter Valve Interventions
Chapter 26: Venovenous Extracorporeal Membrane Oxygenation
Chapter 27: Venoarterial Extracorporeal Membrane Oxygenation
Chapter 28: Percutaneous Ventricular Assist Devices: Left Ventricle / Right Ventricle
Chapter 29: Durable Left Ventricular Assist Devices
Chapter 30: Echocardiography in the Patient on Mechanical Circulatory Support
Chapter 31: Frontiers in Mechanical Circulatory Support: Ventricular Assist Devices for the
Right Ventricle, Adult Congenital, Miniature Ventricular Assist Devices, and Military and
Mobile Extracorporeal Membrane Oxygenation Teams
Chapter 32: Cannulation Strategies
Chapter 33: Transport of Patients on Mechanical Circulatory Support
Chapter 34: Ethics in Mechanical Circulatory Support
,Chapter 1: Left Ventricular Physiology
Context: Mechanics of the left ventricle, including preload, afterload,
contractility, and ejection fraction; effects on cardiac output and systemic
perfusion; relevance in heart failure and cardiogenic shock.
Question 1
A 65-year-old patient in cardiogenic shock has a left ventricular end-diastolic
volume of 150 mL and a normal contractility. Which intervention will most
effectively increase stroke volume according to the Frank-Starling mechanism?
A. Administering a high-dose vasodilator
B. Giving a moderate fluid bolus
C. Initiating high-dose beta-blocker therapy
D. Starting mechanical ventilation with high PEEP
Answer: B
Rationale: Increasing preload via a fluid bolus enhances LV end-diastolic
volume, which stretches myocardial fibers and increases stroke volume via the
Frank-Starling relationship. Vasodilators reduce afterload but do not acutely
increase preload; beta-blockers decrease contractility; high PEEP reduces
venous return, decreasing preload.
Key words: preload, Frank-Starling, stroke volume, cardiogenic shock
Question 2
In a patient with chronic hypertension, the left ventricle develops concentric
hypertrophy. How does this affect afterload and stroke volume?
A. Afterload decreases, stroke volume increases
B. Afterload increases, stroke volume decreases
C. Afterload decreases, stroke volume decreases
D. Afterload increases, stroke volume increases
Answer: B
, Rationale: Concentric hypertrophy increases wall thickness to compensate for
elevated systemic vascular resistance, raising afterload. The stiff ventricle has
reduced compliance, impairing stroke volume despite preserved contractility.
Key words: afterload, LV hypertrophy, stroke volume, compliance
Question 3
A patient with acute myocardial infarction has severely reduced LV
contractility. Which intervention will acutely improve cardiac output?
A. Administration of a negative inotrope
B. Use of an inotropic agent like dobutamine
C. Initiation of beta-blocker therapy
D. Increasing systemic vascular resistance with phenylephrine
Answer: B
Rationale: Dobutamine increases myocardial contractility, enhancing stroke
volume and cardiac output. Negative inotropes worsen output; beta-blockers
reduce contractility acutely; increasing afterload with phenylephrine may
decrease cardiac output in a failing LV.
Key words: contractility, inotrope, cardiac output, acute MI
Question 4
Which parameter best reflects left ventricular contractility independent of
preload and afterload?
A. Stroke volume
B. Ejection fraction
C. End-diastolic volume
D. Systolic blood pressure
Answer: B
Rationale: Ejection fraction (EF) is a relative measure of stroke volume to end-
diastolic volume and reflects contractility independent of absolute preload and
afterload, especially in hemodynamically stable conditions. Stroke volume and
BP are influenced by loading conditions.
