Preload (cardiology)

In cardiac physiology, preload is the amount of sarcomere stretch experienced by cardiac muscle cells, called cardiomyocytes, at the end of ventricular filling during diastole. Preload is directly related to ventricular filling. As the relaxed ventricle fills during diastole, the walls are stretched and the length of sarcomeres increases. Sarcomere length can be approximated by the volume of the ventricle because each shape has a conserved surface-area-to-volume ratio. This is useful clinically because measuring the sarcomere length is destructive to heart tissue. It requires cutting out a piece of cardiac muscle to look at the sarcomeres under a microscope. It is currently not possible to directly measure preload in the beating heart of a living animal. Preload is estimated from end-diastolic ventricular pressure and is measured in millimeters of mercury (mmHg). 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 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.