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CO - RELATION WITH ECG INTRA CARDIAC PRESSURES ASHOK MADRAS MEDICAL MISSION CHENNAI www.anaesthesia.co.in anaesthesia.co.in@gmail.com
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What is the importance of the Intra cardiac pressures ?
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PURPOSE To ASSESS. Severity of Valvular heart disease. Pulmonary Artery Hypertension. Shunt calculation. Cardiomyopathy. Ventricular function. Pulmonary & Systemic flow
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INTRA CARDIAC PRESSURES CO - RELATION WITH ECG
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Rt HEART PRESSURES
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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
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RV PRESSURE TRACING NORMAL RV PRESSURE AVG (mmHg) RANGE (mmHg) Peak systolic 25 15-30 End diastolic 4 1- 7 40 RV - 40
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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 PA PCW
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Lt HEART PRESSURES 100 LV AO
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LV PRESSURE TRACING LV SYSTOLIC 100 NORMAL LV PRESSURE : AVG (mmHg) RANGE (mmHg) PEAK SYSTOLIC 130 9-140 END DIASTOLIC 8 5- 12
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AORTA PRESSURE TRACING NORMAL AO PRESSURE AVG(mmHg) RANGE (mmHg) PEAK SYSTOLIC 130 90-140 END DIASTOLIC 70 60- 90 MEAN 85 70-105 100
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LEFT VENTRICULAR END DIASTOLIC PRESSURE ( LVEDP )
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LV PRESSURE 100 LV
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LVEDP PRESSURE TRACING HOW TO MEASURE LV EDP LV - 40
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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
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ABNORMAL LVEDP
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ELEVATED LVEDP 100 LV
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LV PRESSURE IN AF LV - 100
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PULMONARY CAPILLARY WEDGE PRESSURE
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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
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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.
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PCW - PA PRESSURE TRACING PCW PA 40
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PCW PRESSURE TRACING NORMAL PCW PRESSURE : AVG (mmHg) RANGE(mmHg) MEAN 9 4-12 20
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INDIRECT METHOD. Measurement of the LA pressure. Left atrial measurement: via a PFO ( patent foramen ovale ) Trans septal ( brockenbrough technique )
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LA PRESSURE Waveform 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
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MITRAL STENOSIS
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R wave - ECG LV & PCWP Measurement
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SIMULTANIOUS LV & LA PRESSURES 40 LA & LV
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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
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LV & LA PRESSURE TRACING IN AF LV & LA 40
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CATHETER POSITION PCW & LV LV PCW
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CATHETER POSITION LA & LV LV LA
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HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
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LV TO AO PULL BACK GRADIENT
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RESTING GRADIENT - LV & AO 200 LV & AO
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ECTOPIC GRADIENT 200 LV & AO
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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
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THANK YOU www.anaesthesia.co.in anaesthesia.co.in@gmail.com
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