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CO - RELATION WITH ECG
INTRA CARDIAC PRESSURES
ASHOKMADRAS MEDICAL MISSION CHENNAI
www.anaesthesia.co.in [email protected]
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 PRESSURESCO - RELATION WITH ECG
Rt HEART PRESSURES
RA PRESSURE TRACING
NORMAL RA PRESSURE :a wave - 6 2-7
AVG(mmHg) RANGE(mmHg)
v wave - 5 2-7
mean - 3 1-5
RA -20
20
RV PRESSURE TRACING
NORMAL RV PRESSURE AVG (mmHg) RANGE (mmHg)
Peak systolic 25 15-30
End diastolic 4 1- 7
40
RV - 40
PCW AND PA PRESSURE TRACING
NORMAL
PCW AVG(mmHg) RANGE(mmHg)
Mean 9 4-12
NORMAL
PA AVG(mmHg) RANGE(mmHg)
Peak Systolic 25 15-30
End diastolic 9 4- 12
Mean 15 9-19
40
PAPCW
Lt HEART PRESSURES
100
LV AO
LV PRESSURE TRACINGLV SYSTOLIC
100
NORMAL LV PRESSURE : AVG (mmHg) RANGE (mmHg)PEAK SYSTOLIC 130 9-140END DIASTOLIC 8 5- 12
AORTA PRESSURE TRACING
NORMAL AO PRESSURE AVG(mmHg) RANGE (mmHg)PEAK SYSTOLIC 130 90-140END DIASTOLIC 70 60- 90MEAN 85 70-105
100
LEFT VENTRICULAREND DIASTOLIC PRESSURE
( LVEDP )
LV PRESSURE
100
LV
LVEDP PRESSURE TRACINGHOW 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 5 - 12 mmHg
ABNORMAL LVEDP
ELEVATED LVEDP
100LV
LV PRESSURE IN AF
LV - 100
PULMONARY CAPILLARY WEDGEPRESSURE
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 9 4-12
20
INDIRECT METHOD
. Measurement of the LA pressure
. Left atrial measurement:
via a PFO ( patent foramen ovale )
Trans septal ( brockenbrough technique )
LA PRESSUREWaveform 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 4 - 12 mmHg
MITRAL STENOSIS
R wave - ECG
LV & PCWP Measurement
SIMULTANIOUS LV & LA PRESSURES
40LA & 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 & LA40
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
200LV & 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
