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Year 3 Cardiac physiology > CC3: Normal pressures > Flashcards

CC3: Normal pressures Flashcards

1
Q

What are the 2 types of blood pressure?

A

-Systemic
-Pulmonary

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2
Q

How do we obtain invasive blood pressure?

A

-Catheter connected at its proximal end to a pressure monitoring transducer
-Transducer converts mechanical waveforms from circulatory system into electrical waveform
-Waveforms are recorded individually as catheter passes through heart and vessels

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3
Q

How do you access right and left heart?

A

Right heart: Vein (e.g. femoral)
Left heart: Artery (e.g. radial)

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4
Q

Journey of catheter to left heart?

A

-Femoral artery
-Descending aorta
-Ascending aorta
-Aortic valve
-Left ventricle

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5
Q

What type of pressure trace is this?

A

-Arterial trace
-Systolic > 100 = systemic, not pulmonary

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6
Q

What is the difference between left side and right side arterial pressure traces?

A

-Same shape
-But right side has lower values
-E.g. Pulmonary artery <30 systolic

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7
Q

Describe arterial pressure trace

A

-Starts when aortic valve opens
-Sharp upstroke which reflects ejection of blood from left ventricle
-Normal systolic = 100-140
-Normal diastolic = 60-90

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8
Q

What does diastolic pressure relate to and what can increase it?

A

-Relates to the amount of recoil in the arterial system
-Fast heart rate, shorter diastolic time, less time for run off into distal branches, higher diastolic pressure

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9
Q

Why does the diastolic value in arterial pressure trace never drop to zero?

A

-Aorta is a strong, thick-walled vessel
-Pressure is maintained so that even at peripheries, all cells are supplied with oxygen

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10
Q

What is the anachrotic notch?

A

-During first phase of ventricular systole, (isovolumetric contraction), a presystolic rise may be seen
-This occurs before the opening of the aortic valve

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11
Q

What is the dichrotic notch?

A

-Aorta has greater pressure than left ventricle
-Blood flow attempts to equalise by flowing backwards
-Causes closure of aortic valve
-Marks end of systole and beginning of diastole

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12
Q

What is the pulse pressure?

A

-Difference between systolic and diastolic pressure

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13
Q

What factors affect pulse pressure?

A

-Changes in stroke volume
-Aortic regurgitation
-Changes in vascular compliance

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14
Q

Aortic compliance

A
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15
Q

What is the mean arterial pressure (MAP) and how do we calculate it?

A

-an approximation of a time-weighted average of blood pressure values in large system arteries during the cardiac cycle

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16
Q

What type of pressure trace is this?

A

-Left Ventricular
-Falls close to zero

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17
Q

What features make up the left ventricle?

A

-Thickest wall
-Left common bundle (left anterior/posterior fascicle)
-Aortic valve (3 cusps)

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18
Q

What is the normal area of aortic valve?

A

2.5-3.5cm^2

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19
Q

What happens during ventricular systole?

A

Isovolumetric contraction
-all 4 valves closed
-after closure of mitral, before opening of aortic
-rapid rise in pressure until it exceeds aortic pressure and aortic valve opens

Ejection phase
-blood flows into aorta until aortic valve closes

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20
Q

What happens during ventricular diastole?

A

-Relaxation of the ventricle allows ventricular filling
(aortic valve closes and mitral valve opens)

Diastasis
-later, slower period of filling when left ventricle is nearly full
-pressure in LV = pressure in LA

21
Q

What is the EDV?

A

-End Diastolic Volume
-Amount of blood in the ventricles before heart contracts

22
Q

What 2 positions can EDP be measured at?

A

-Pre-A (beginning of R wave)
-Post-A (peak of R wave)

23
Q

Journey of catheter to right heart?

A

-SVC/IVC
-RA
-Tricuspid valve
-RV
-Pulmonary artery
-Pulmonary capillary wedge (LA)

24
Q

How much does does atrial kick contribute to ventricular filling

A

-Active filling due to atrial contraction contributes 30% of Ventricular filling

25
Q

Which 3 vessels drain into right atrium?

A

-SVC
-IVC
-Coronary sinus

26
Q

What is the area of the tricuspid valve and how many leaflets?

A

5-10cm^2
3 leaflets

27
Q

Which pressure trace is this?

A

-Atrial/venous

28
Q

What do A wave and V wave represent?

A

A wave
-Generated when atrium contracts
-Causes pressure increase in atrium
-Occurs after P wave

V wave
-Increase in pressure during ventricular systole
-Occurs after T wave

29
Q

What do C, X and Y waves represent?

A

X descent
-Fall in pressure following a wave (represents atrial relaxation)
Y descent
-Fall in pressure following v wave
(represents opening of AV valve)
C wave
-May occur as interruption of X descent and represents movement of AV valve towards atrium during closure

30
Q

What are the normal pressure values for right ventricle?

A

-Systole <30
-Diastole <5

31
Q

Causes of increased pressure in right ventricle

A

-Hypervolemia
-Pulmonary embolism
-COPD
-Pulmonary stenosis
-RV infarct/failure
-Pericarditis/tamponade
-Oytflow obstruction
-Primary and secondary pulmonary hypertension
-LV failure

32
Q

What pressure trace is this?

A

-Right side because low values
-Arterial shape
-So pulmonary artery

33
Q

What are the 3 pressure waveform traces?

A

-Arterial - Pulmonary artery/Aorta
-Ventricular - LV and RV
-Atrial/Venous

34
Q

Causes of increased and decreased pressure in pulmonary artery?

A

Decreased:
-Hypovolemia

Increased:
-PHTN
-COPD
-ARDS
-PE
-Mitral stenosis

35
Q

Mitral valve area and how many leaflets?

A

4-6cm^2
2 leaflets

36
Q

Left atrial vs Right atrial pressure

A

-Similar waveform
-A wave and V wave larger in left atrium due to lower compliance

37
Q

What is Pulmonary Capillary Wedge (PCW)?

A

-Used to assess LA pressure
-Based on assumption that pressure in pulmonary capillaries = LA
-Catheter is wedged into pulmonary capillaries, giving
indirect LA pressure measurement
-Estimates LVEDP so is an indicator or LVEDV

38
Q

How would you obtain direct LA pressure measurement?

A

-Patent Foramen Ovale
-Trans-septal technique using puncture (Brockenborough) technique

39
Q

Normal PCW pressure

A

6-12mmHg
-PCW > 18mmHg suggests left heart failure
-Used to quantify degree of mitral stenosis/pulmonary hypertension

40
Q

What causes increase/decrease of PCW?

A

Decrease:
-Hypovolemia
Increase:
-Mitral stenosis/regurgitation
-Aortic stenosis/regurgitation
-LV ischaemia/infarct
-LV failure

41
Q

Summary of right heart pressure

A
42
Q

Normal values

A
43
Q

LV-AO pullback

A

-Measures pressure gradient between left ventricle and aorta
-Aortic stenosis?

44
Q

Mean pressure difference

A

-2 pressure traces
-Compares difference in mean pressure between left ventricle and aorta

45
Q

LV and PCW

A

-Measures pressure difference between LA and LV
A wave > V wave = MS
V wave > A wave = MR

46
Q

What is this?

A

-No pulmonary valve defect because no pressure gradient
-But pulmonary hypertension due to systolic pressure of 57mmHg

47
Q

Which pullback are these?

A

-LV -> Aorta
-PA -> RV

48
Q

Systolic BP values by age

A
49
Q

How to work out which pressure waveform?

A

Year 3 Cardiac physiology (30 decks)

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