1. CO - RELATION WITH ECG INTRA CARDIAC PRESSURES ASHOK MADRAS MEDICAL MISSION CHENNAI www.anaesthesia.co.in anaesthesia.co.in@gmail.com

2. What is the importance of the Intra cardiac pressures ?

3. PURPOSE To ASSESS. Severity of Valvular heart disease. Pulmonary Artery Hypertension. Shunt calculation. Cardiomyopathy. Ventricular function. Pulmonary & Systemic flow

4. INTRA CARDIAC PRESSURES CO - RELATION WITH ECG

5. Rt HEART PRESSURES

6. 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

7. RV PRESSURE TRACING NORMAL RV PRESSURE AVG (mmHg) RANGE (mmHg) Peak systolic 25 15-30 End diastolic 4 1- 7 40 RV - 40

8. 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

9. Lt HEART PRESSURES 100 LV AO

10. LV PRESSURE TRACING LV SYSTOLIC 100 NORMAL LV PRESSURE : AVG (mmHg) RANGE (mmHg) PEAK SYSTOLIC 130 9-140 END DIASTOLIC 8 5- 12

11. 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

12. LEFT VENTRICULAR END DIASTOLIC PRESSURE ( LVEDP )

13. LV PRESSURE 100 LV

14. LVEDP PRESSURE TRACING HOW TO MEASURE LV EDP LV - 40

15. 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

16. ABNORMAL LVEDP

17. ELEVATED LVEDP 100 LV

18. LV PRESSURE IN AF LV - 100

19. PULMONARY CAPILLARY WEDGE PRESSURE

20. 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

21. 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.

22. PCW - PA PRESSURE TRACING PCW PA 40

23. PCW PRESSURE TRACING NORMAL PCW PRESSURE : AVG (mmHg) RANGE(mmHg) MEAN 9 4-12 20

24. INDIRECT METHOD. Measurement of the LA pressure. Left atrial measurement: via a PFO ( patent foramen ovale ) Trans septal ( brockenbrough technique )

25. 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

26. MITRAL STENOSIS

27. R wave - ECG LV & PCWP Measurement

28. SIMULTANIOUS LV & LA PRESSURES 40 LA & LV

29. 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

30. LV & LA PRESSURE TRACING IN AF LV & LA 40

31. CATHETER POSITION PCW & LV LV PCW

32. CATHETER POSITION LA & LV LV LA

33. HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

34. LV TO AO PULL BACK GRADIENT

35. RESTING GRADIENT - LV & AO 200 LV & AO

36. ECTOPIC GRADIENT 200 LV & AO

37. 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

38. THANK YOU www.anaesthesia.co.in anaesthesia.co.in@gmail.com