Valvular - Hemodynamics Flashcards
Normal pressure within Heart chamber
RA - 3 (1-5)
RV systolic - 25 (15-50
end-diastolic - 4 (1-7)
PA- 15 (9-19)
PCW - 9 (4-12)
LA 8 (1-12)
LV 130 (90-140)
end-diastolic - 8 (2-12)
Ao
systolic 130 (90-140)
mean 85 (70-105
normal Cardiac Index?
2.5-4.0L/mi/m2
Components of CVP
A wave- atrial contraction
- occurs during atrial systole of diastole
after P wave in the ECG
X descent - atrial relaxation and descent of the TV annulus.
–>AV valves closes at the end of 1st X descent
C wave- Contraction of ventricle in a close AV valve during isometric ventricular contraction
–> semilunar Valves - opens at the peak of C Wave
V wave- Venous return,
reaching its max during the end of isovolumetric relaxation
—> semilunar valves closes first, start of V wave
—> AV valves open at the peak of V wave
Y descent - opening of the TV valve/early ventricular filling
HF with cardiac index of >4.0. what are the differential diagnosis?
- Obesity
- anemia
- fistula (acquired or AVF)
- liver disease
- beriberi
-thyroid disease
in CVP, what waves occur during systole and diastole
during systole
- C wave,
- 2nd X Descent
-start of V wave
during diastole
- peak of V wave
- Y descent
- A wave
-1st X descent
echo doppler findings in Tamponade
check mitral inflow
changes in CVP in Tamponade
- blunted Y descent
changes in CVP in constrictive pericarditis
- Prominent X and Y descents
Echo findings in constrictive pericarditis
- check for
1. IVC (dilated) and Mitral inflow E/A >0.8
- Ventricular septal motion abnormality with respiration/ respirophasic septal shift
- Mitral Medial e’ >8 cm/s
- Hepatic vein expiratory end-diastolic reversal velocity/forward flow velocity of ≥0.8
- Mitral medial e’ > lateral e’ (annulus reversus)
question?
answer is B
arterial o2 sat - mixed venous/
PV venous sat - PA o2 sat
***mixed venous = SVCx3 + IVC / 4
what is a significant step up?
SVC to PA - 8% - screening
mixed venous to PA - 7%
PA >80%- suspect significant shunt
systemic arterial o2 sat of <93% that persist despite taking breath, consider R-to-L shunt
An absolute increase in oxygen saturation by 5% or more defines a significant step- up and the location of the shunt.
what is this sign of what disease?
Brockenbrough-Braunwald Morrow sign
- HOCM-
- Subaortic membrane with dynamic LVOT obstruction
consideration for a delayed upstroke in invasive hemodynamics
Fixed LVOT obstruction
what does this hemodynamic findings means?
yellow-aorta
orange- LV pressure
- after a PVC
- Dynamic LVOT obstruction
fixed vs dynamic LVOT obstruction on hemodynamics?
(post PVC response in LVOT obstruction)
1st part- fixed
2nd part - dynamic, look at the difference in after the PVC
question?
answer is A
PVR = mean PA-LA or PAWP / CO
What is the PAWP for pre and post capillary PH?
Pre
PAWP <15
post
PAWP ≥15
(but is PVR is >2.0 WU)- consider Mixed
what is the diagnosis?
severe TR
T/F?
Dynamic ventricular interdependence (correspondence of LV- RV systolic pressures) exhibited during respiration, on the other hand, is the most sensitive and specific hemodynamic finding differentiat- ing constrictive pericarditis from restrictive physiology.
True
T/F
The traditional hemodynamic criteria for the diagnosis of constrictive pericarditis include
(1) end- diastolic pressure equalization (LV end- diastolic pressure minus RV end- diastolic pressure >5 mm Hg),
(2) PAP <55 mm Hg,
(3) RV end- diastolic pressure divided by RV systolic pressure >1/3,
(4) dip and plateau diastolic pressure morphology as reflected by the height of the LV rapid filling wave (>7 mm Hg),
(5) and Kussmaul’s sign (lack of an inspiratory fall in mean right atrial pressure)
TRUE
