In the context of arterial stiffness increasing afterload, which of the following PV loop changes would you expect?

• A. Lower systolic pressure and larger stroke volume.
• B. Higher systolic pressure and smaller stroke volume.
• C. No change in loop shape.
• D. Longer diastolic filling time.

Answer: (B)

Arterial stiffness raises afterload, the pressure the ventricle must overcome to eject blood. When afterload is higher, the ventricle can eject less blood, so stroke volume falls. At the same time, the ventricle must generate more pressure to overcome the stiff arteries, so the peak systolic pressure rises. On the PV loop, this looks like a loop that is taller (higher end-systolic pressure) and narrower (smaller stroke volume). Diastolic filling time isn’t the main change driven by afterload, so the primary shifts are in systolic pressure and stroke volume.