Cardiac Cycle and Hemodynamics · USMLE Step 1

Which change would you expect in the left ventricular pressure–volume loop if afterload is acutely increased (e.g., acute hypertension)?

  1. Leftward shift in the loop with increased stroke volume
  2. Rightward shift, higher end-diastolic volume, lower stroke volume
  3. A taller but narrower loop reflecting increased contractility
  4. No change in end-diastolic or end-systolic volumes
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Correct answer: Rightward shift, higher end-diastolic volume, lower stroke volume

An acute afterload increase means the ventricle must generate higher pressure before ejection; this delays ejection, leading to increased end-diastolic volume (preload), and typically reduces stroke volume — shifting the loop rightward.

Difficulty: Medium Question 17 of 21

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