lancashire & south cumbria cardiac network left heart pressure findings – valvular ... •...
TRANSCRIPT
Abnormal Pressures
Lancashire & South Cumbria Cardiac Network
Abnormal Left Heart Pressure Findings – Valvular
Disease • Aortic stenosis
• Aortic Regurgitation
• Mitral stenosis
• Mitral Regurgitation
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
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
Measurement
• LV to Ao Pullback
• LV & Ao superimposed
Peak measurement
Mean measurement
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
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
Measurement
• Seen on aortic pressure trace
• Can also lead to an increased LVEDP
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)
Measurement
• Increase PCWP – ‘a’ wave > 12 mmHg
• Gradient seen between PCWP & LVEDP
Peak measurement
Mean measurement
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
Measurement
• PCWP trace elevated
• ‘v’ wave > 12 mmHg
Abnormal Right Heart Pressure Findings
• Pulmonary Stenosis
• Pulmonary Regurgitation
• Tricuspid Stenosis
• Tricuspid Regurgitation
• Apply the same principles to the corresponding valve on the right side
• Assess the valve during the appropriate part of the cardiac cycle
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
Measurement
• PA to RV pullback
• PA & RV superimposed
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
Measurement
• Seen on PA trace
• Can lead to an elevated RVEDP
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
Measurement
• Elevated ‘a’ wave seen on RA trace
• Gradient seen between RA & RVEDP
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
Measurement
• Large ‘v’ wave seen on RA trace‘
Summary
• Aortic/Pulmonary Stenosis – ventricular systole – elevated LV/RV pressure
• Aortic/Pulmonary Regurgitation –ventricular diastole – drop Ao/PA diastolic pressure
Summary
• Mitral/Tricuspid Stenosis – ventricular diastole – elevated LA/RA pressure
• Mitral/Tricuspid Regurgitation – ventricular systole – elevated LA/RA pressure(V wave)