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In the latter situation, ventilator settings and blood gases contribute to RV failure besides the pulmonary pathology. 8 In case of chronically increased RV afterload (e.g. chronic pulmonary hypertension), RV adaptation may become unbalanced by an acute intercurrent event such as infection, arrhythmia, or embolism (acute-on-chronic cor .In PV loop diagrams, increased inotropy increases the slope of the end-systolic pressure-volume relationship (ESPVR; upper dashed lines in figure), which permits the ventricle to generate more pressure at a given LV volume. Decreasing inotropy has the opposite effects; namely, increased end-systolic volume and decreased stroke .
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