Central Venous Pressure (CVP)

 The large veins (IVC, SVC) are represent

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