Central venous pressure (CVP) is measured via a catheter inserted into the jugular vein to measure pressure in the right atrium. The CVP waveform contains A, C, V, and X waves corresponding to atrial contraction and relaxation. Abnormal waveforms can provide clues to conditions like mitral stenosis (prominent A wave), aortic insufficiency (low end-diastolic gradient), or constrictive pericarditis (elevated waves and steep descents). Interpreting pressure waveforms throughout the heart and vessels aids in diagnosis of valve diseases and other cardiac abnormalities.
Central venous pressure (CVP) is measured via a catheter inserted into the jugular vein to measure pressure in the right atrium. The CVP waveform contains A, C, V, and X waves corresponding to atrial contraction and relaxation. Abnormal waveforms can provide clues to conditions like mitral stenosis (prominent A wave), aortic insufficiency (low end-diastolic gradient), or constrictive pericarditis (elevated waves and steep descents). Interpreting pressure waveforms throughout the heart and vessels aids in diagnosis of valve diseases and other cardiac abnormalities.
Central venous pressure (CVP) is measured via a catheter inserted into the jugular vein to measure pressure in the right atrium. The CVP waveform contains A, C, V, and X waves corresponding to atrial contraction and relaxation. Abnormal waveforms can provide clues to conditions like mitral stenosis (prominent A wave), aortic insufficiency (low end-diastolic gradient), or constrictive pericarditis (elevated waves and steep descents). Interpreting pressure waveforms throughout the heart and vessels aids in diagnosis of valve diseases and other cardiac abnormalities.
the CVP. They run into the RA A catheter can be inserted into the jugular vein and passed down towards the RA, and connected to a pressure transducer measures the CVP. Essentially identical to the RA pressure Central Venous Pressure (CVP) A wave – first positive wave of atrial pressure (follows the P wave on the ECG) X descent – first negative wave after the A wave (represents atrial relaxation) C wave – second positive wave associated with ICVT and the closure of the MV the ventricular contraction Central Venous Pressure (CVP) X1 descent- represents the pulling down of the septum during ventricular ejection as the heart contracts inward (X before the C and X1 after the C sometimes only one is noted on grafts) V wave – third positive wave represents the low pressure in the atrial rising because of venous filling (pooling) Y descent – early atrial emptying RA Because there is no valve between the venous circulation and the RA and CVP the terms are used interchangeably RV RV pressure tracing consists of a rapid upsweep coinciding with IVCT. When pressure created by the contraction increases over the RA pressure, the TV opens and pressure continues to rise in the RV until the PV opens and blood is ejected into the pulmonary arteries RV PA The tracing begins with an upstroke correlating t the opening of the pulmonic valve and goes up t a systolic to a systolic peak, as blood flow runs off into the pulmonary beds the pressure tracing descends. As the PA pressure decreases, the pulmonic closes creating a diachrotic notch in the pressure waveform PA Pulmonary Capillary Wedge - PCW Indirect measurement of the LA and in the absence of MV disease the LVed pressure Measured by floating an end hole balloon catheter out through the pulmonary artery until the catheter occludes a small branch The balloon is then carefully inflated – blocking off all blood flow to give a reflection of left heart activity. Similar to the RA and LA pressure tracings with and A,C,V waves PCWP Summary of Right Heart LA Same as the RA waveforms but greater magnitude Physically difficult to insert a catheter for the measurement of LA pressure. Not a good idea to transeptal puncture the IAS not unless it is necessary. So the PCWP is used LV Similar to the RV pressure tracings but 5 times the amplitude Sharp upstroke indicates isovolumetric contraction As the pressure rises, the aortic valve opens and pressure continues to rise until the rapid ejection phase. As blood goes through the aortic valve into the aorta, the pressure drops and the aortic valve closes. When the pressure drops below the level of the LA, the MV opens and blood begins to passively fill the LV producing a brief upward deflection on the pressure tracing. LV, aorta, LA pressure waveforms Aorta Pressures will vary depending on where they are obtained Generally, the more distal the catheter location from the ascending aorta, the higher the systolic pressure, the sharper and later the systolic upstroke. Aorta The arterial pressure tracing is characterized by a swift upstroke that begins with the opening of the aortic valve Pressure peaks as blood runs off into the vascular system the pressure descends. As the pressure falls the aortic valve snaps shut. This is seen on ascending and descending aortic pressure waveforms as a diachrotic notch The diachrotic notch is usually not visible on femoral and brachial tracings because of the distance form the aorta Aorta Abnormal Pressure Waveforms Abnormal pressures and loading can affect the pressure waveform profiles, the primary determinant is volume of blood in the arteries and the heart. Direct relationship, the more volume the more pressure. Other factors: Cardiac output Prepherial resistance Some Common Abnormal Waveforms Higher pressure and volume in the atrial produces a large V wave or it merges with the C wave on the atrial pressure wave form Some Common Abnormal Waveforms Acute AI produces a low end diastolic gradient where chronic mild regurgitation looks more normal and has a high end diastolic grdient Some Common Abnormal Waveforms Mitral Stenosis produces a prominent A wave on the LA pressure waveform along with a gradient between the LA and LV Some Common Abnormal Waveforms The PCWP will also increase in MS due to the added resistance in the lungs which will affect right sided pressures Some Common Abnormal Waveforms To further complicate things, the PA pressure would increase as and the patient may have pulmonary hypertention Some Common Abnormal Waveforms Constrictive pericarditis or restrictive cardiomyopathy Note the elevated A and V waves and Steep X and Y descents RA pressure is elevated Some Common Abnormal Waveforms Aortic Stenosis Usually this waveform in the aorta is compared to the LV. It can then be noted that there is a slow rise in pressure in the aorta (pulsus paravus et. tardus) and an anachrotic notch will appear because of a stiff valve. Some Common Abnormal Waveforms Aortic Stenosis Some Common Abnormal Waveforms Mitral Stenosis Some Common Abnormal Waveforms Mitral Stenosis High LA gradient Throughout systole and diastole Some Common Abnormal Waveforms Mitral Insufficiency Increase in “V” wave Some Common Abnormal Waveforms Tricuspid Stenosis Some Common Abnormal Waveforms Aortic Insufficiency Severe AI has a low end-diastolic gradient Some Common Abnormal Waveforms Subaortic, supraaortic and aortic waveforms comparison with stenosis at all sights. Some Common Abnormal Waveforms Constrictive pericarditis Restrictive cardiomyopathy Both pericarditis and restrictive cardiomyopathy have an early diastolic dip and plateau Tamponade has equalization of diastolic pressures