CO - RELATION WITH ECG INTRA CARDIAC PRESSURES ASHOK MADRAS MEDICAL MISSION CHENNAI [email protected].

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

THANK YOU

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