CO - RELATION WITH ECG INTRA CARDIAC PRESSURES ASHOK MADRAS MEDICAL MISSION CHENNAI

What is the importance of the Intra cardiac pressures ?

PURPOSE To ASSESS. Severity of Valvular heart disease. Pulmonary Artery Hypertension. Shunt calculation. Cardiomyopathy. Ventricular function. Pulmonary & Systemic flow

INTRA CARDIAC PRESSURES CO - RELATION WITH ECG

Rt HEART PRESSURES

RA PRESSURE TRACING NORMAL RA PRESSURE : a wave AVG(mmHg) RANGE(mmHg) v wave mean RA

RV PRESSURE TRACING NORMAL RV PRESSURE AVG (mmHg) RANGE (mmHg) Peak systolic End diastolic RV - 40

PCW AND PA PRESSURE TRACING NORMAL PCW AVG(mmHg) RANGE(mmHg) Mean NORMAL PA AVG(mmHg) RANGE(mmHg) Peak Systolic End diastolic Mean PA PCW

Lt HEART PRESSURES 100 LV AO

LV PRESSURE TRACING LV SYSTOLIC 100 NORMAL LV PRESSURE : AVG (mmHg) RANGE (mmHg) PEAK SYSTOLIC END DIASTOLIC

AORTA PRESSURE TRACING NORMAL AO PRESSURE AVG(mmHg) RANGE (mmHg) PEAK SYSTOLIC END DIASTOLIC MEAN

LEFT VENTRICULAR END DIASTOLIC PRESSURE ( LVEDP )

LV PRESSURE 100 LV

LVEDP PRESSURE TRACING HOW TO MEASURE LV EDP LV - 40

LVEDP is measured just before the start of the systole ( i.e : End of the diastole ) End Diastolic pressure can be measured on the R wave of the ECG. Normal LVEDP range mmHg

ABNORMAL LVEDP

ELEVATED LVEDP 100 LV

LV PRESSURE IN AF LV - 100

PULMONARY CAPILLARY WEDGE PRESSURE

Pulmonary capillary wedge pressure. DIRECT method : placement of a Swan Ganz catheter,. INDIRECT method : assume that the LA pressure is the wedged into the pulmonary capillaries. same as PCWP

DIRECT METHOD. Placement of a Swan Ganz catheter in the pulmonary circulation.. Tip should be in the most distal position with the balloon inflated.. Wedge the catheter.. Loss of the waveforms.. Measure the value.

PCW - PA PRESSURE TRACING PCW PA 40

PCW PRESSURE TRACING NORMAL PCW PRESSURE : AVG (mmHg) RANGE(mmHg) MEAN

INDIRECT METHOD. Measurement of the LA pressure. Left atrial measurement: via a PFO ( patent foramen ovale ) Trans septal ( brockenbrough technique )

LA PRESSURE Waveform is similar to RA - slightly higher ‘a’ wave : Atrial contraction ( PR interval - ECG ) x descent : Atrial relaxation ‘c’ wave due to ventricular systole (not of much importance) ‘v’ wave : Atrial filling ( T-P INTERVAL - ECG ) y descent : atrial emptying. Normal LA pressure range mmHg

MITRAL STENOSIS

R wave - ECG LV & PCWP Measurement

SIMULTANIOUS LV & LA PRESSURES 40 LA & LV

GRADIENT across MV. Pressure difference between LA and LV. Measured in diastole.. We need LA pressure and LVEDP.. Peak MV gradient = Peak LA pr - LVEDP. Mean MV gradient = Mean LA pr - LVEDP

LV & LA PRESSURE TRACING IN AF LV & LA 40

CATHETER POSITION PCW & LV LV PCW

CATHETER POSITION LA & LV LV LA

HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

LV TO AO PULL BACK GRADIENT

RESTING GRADIENT - LV & AO 200 LV & AO

ECTOPIC GRADIENT 200 LV & AO

CONCLUSION PRESSURE STUDY IS IMPORTANT FOR COMPLETE EVALUATION OF THE PATIENT PRESSURE TRACINGS AND RESPECTIVE VALUES SHOULD ALWAYS BE CORELATED WITH ECG AND CARDIAC DISEASE

THANK YOU