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
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