Toward consistent definitions for preload and afterload

Significant differences exist among textbook definitions for the terms preload and afterload, leading to confusion and frustration among students and faculty alike. Many faculty also chose to use in their teaching simple terms such as "end-diastolic volume" or "aortic pressure" as common-usage approximations of preload and afterload, respectively, but these are only partial representations of these important concepts. Straightforward definitions both of preload and afterload that are concise yet still comprehensive can be developed using the Law of LaPlace to describe the relationships among chamber pressure, chamber radius, and wall thickness. Within this context, the term "preload" can be defined as all of the factors that contribute to passive ventricular wall stress (or tension) at the end of diastole, and the term "afterload" can be defined as all of the factors that contribute to total myocardial wall stress (or tension) during systolic ejection. The inclusion of "wall stress" in both definitions helps the student appreciate both the complexities of cardiac pathophysiology and the rationale for therapeutic intervention.