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Abnormal Pressures
Lancashire & South Cumbria Cardiac Network
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Abnormal Left Heart Pressure Findings – Valvular
Disease • Aortic stenosis
• Aortic Regurgitation
• Mitral stenosis
• Mitral Regurgitation
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Stenosis -Pressure Gradient
• Used to assess the presence and severity of valvular stenosis
• Measured during the part of the cardiac cycle when the valve assessed should be fully open
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Aortic Stenosis
• Measured during ventricular systole – when Aortic valve should be fully open
• Therefore measure of systolic pressure
• Gradient – difference in systolic pressures across Aortic valve
• between LV and Aorta
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Measurement
• LV to Ao Pullback
• LV & Ao superimposed
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Peak measurement
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Mean measurement
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Regurgitation
• Used to assess the presence and severity of valvular incompetence
• Measured during the part of the cardiac cycle when the valve assessed should be fully closed
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Aortic Regurgitation
• Measured during ventricular diastole –when Aortic valve should be fully closed
• Therefore it is a measure of diastolic pressure
• Seen as a low diastolic Aortic pressure measurement
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Measurement
• Seen on aortic pressure trace
• Can also lead to an increased LVEDP
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Mitral stenosis• Measured during ventricular diastole - when
Mitral Valve should be fully open
• Therefore it is a measure of diastolic pressure
• Gradient – difference in diastolic pressures across mitral valve
• Between LV & LA (PCWP)
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Measurement
• Increase PCWP – ‘a’ wave > 12 mmHg
• Gradient seen between PCWP & LVEDP
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Peak measurement
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Mean measurement
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Mitral Regurgitation
• Measured during ventricular systole- when Mitral valve should be fully closed
• Therefore it is a measure of systolic pressure
• Seen as a high ventricular systolic measurement (V- wave) on the LA (PCWP) trace
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Measurement
• PCWP trace elevated
• ‘v’ wave > 12 mmHg
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Abnormal Right Heart Pressure Findings
• Pulmonary Stenosis
• Pulmonary Regurgitation
• Tricuspid Stenosis
• Tricuspid Regurgitation
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• Apply the same principles to the corresponding valve on the right side
• Assess the valve during the appropriate part of the cardiac cycle
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Pulmonary Stenosis• Measured during ventricular systole – when
Pulmonary valve should be fully open
• Therefore measure of systolic pressure
• Gradient – difference in systolic pressures across Pulmonary valve
• Between RV & PA
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Measurement
• PA to RV pullback
• PA & RV superimposed
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Pulmonary Regurgitation
• Pulmonary Regurgitation
• Measured during ventricular diastole –when Pulmonary valve should be fully closed
• Therefore it is a measure of diastolic pressure
• Seen as a low diastolic pulmonary pressure measurement
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Measurement
• Seen on PA trace
• Can lead to an elevated RVEDP
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Tricuspid stenosis• Measured during ventricular diastole - when
Tricuspid Valve should be fully open
• Therefore it is a measure of diastolic pressure
• Gradient – difference in diastolic pressures across Tricuspid valve
• Between RV & RA
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Measurement
• Elevated ‘a’ wave seen on RA trace
• Gradient seen between RA & RVEDP
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Tricuspid Regurgitation
• Measured during ventricular systole- when Tricuspid valve should be fully closed
• Therefore it is a measure of systolic pressure
• Seen as a high systolic measurement (V- wave) on the RA trace
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Measurement
• Large ‘v’ wave seen on RA trace‘
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Summary
• Aortic/Pulmonary Stenosis – ventricular systole – elevated LV/RV pressure
• Aortic/Pulmonary Regurgitation –ventricular diastole – drop Ao/PA diastolic pressure
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Summary
• Mitral/Tricuspid Stenosis – ventricular diastole – elevated LA/RA pressure
• Mitral/Tricuspid Regurgitation – ventricular systole – elevated LA/RA pressure(V wave)