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Right heart catheterization: Difference between revisions
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(Created page with "== Right heart catheterization == === Introduction === Right heart catheterization (or pulmonary artery catheterization) provides information about hemodynamics of the circu...") |
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#Dip-and-plateau in constrictive pericarditis and restrictive myopathies | #Dip-and-plateau in constrictive pericarditis and restrictive myopathies | ||
== Pulmonary artery pressure == | |||
[[File:PulmonaryArtery_Fig1.png | 300px | left | sys= RV systole | |||
D= dicrotic notch = closure of the pulmonic valve | |||
ed= end-diastolic pressure]] | |||
''Normal PA pressure 25 / 9 mmHg (mean 15)'' | |||
''Abnormal pulmonary artery pressure waveforms'' | |||
#Elevated systolic pressure: idiopathische pulmonary hypertension, pulmonary disease, hypoxemia with pulmonary vasoconstriction, mitral stenosis or regurgitation, restrictive cardiomyopathies, significant cardiac left to right shunt, pulmonary embolism | |||
#Reduced pulce pressure: RV ischaemia or infarction, pulmonary embolism, tamponade | |||
== Pulmonary capillary wedge pressure (PCWP) == | |||
[[File:PulmonaryCapillary_Fig1.png | 300px | left | a= atrial contraction | |||
x= atrial relaxation | |||
v= atrial diastole (ventricular contraction) | |||
y= passive filling of the LV after mitral valve opening]] | |||
''Normal PCWP pressure range = 4-12 mmHg (mean 9) | |||
''When there is no obstruction between left atrium and left ventricle: PCWP = LA pressure = LVEDP. | |||
A true wedge pressure can be measured only in the absence of flow”, meaning with a vessel closed for flow by a balloon. | |||
Normally PCWP equals LAP equals LVEDP. | |||
The PCWP is higher than the LVEDP in: | |||
*Mitral stenosis | |||
*LA obstruction by myxoma | |||
*Mitral regurgitation | |||
*Pulmonary embolism or veno-occlusive disease | |||
*Respiratory failure (hypoxemia and pulmonary vasoconstriction) | |||
The LVEDP is higher than the wedge in: | |||
*Diastolic dysfunction, positive end-expiratory airway pressure | |||
*Myocardial infarction | |||
*Tamponade | |||
*Aortic regurgitation (early closure mitral valve) | |||
''4.8 Abnormal PCWP pressure'' | |||
#Low mean pressure: hypovolemia | |||
#Elevated mean pressure: intravascular overload, LV failure caused by myocardial disease, systemic hypertension or valvular disease (MS, AoS, AoR), pericardial effusion with tamponade | |||
#Elevated a wave: mitral stenosis, diastolic dysfunction, LV volume overload | |||
#Cannon a wave due to atrial-ventricular asynchrony | |||
#Elevated v wave: mitral regurgitation, LV failure, VSD | |||
[[File:PulmonaryCapillary_Fig2.png | 300px | left | Figure 10. Prominent v wave in mitral regurgitation.]] | |||
== Complications == | |||
Possible complications of right heart catheterization are (next to complications at the puncture site) are rhytm disorders (atrial extrasystole, ventricular extrasystole, ventricular tachycardia, ventricular fibrillation), conduction disorders (RBBB, this can be exceptionally dangerous in case of a preexisting LBBB, when a complete heart block develops), damage to the pulmonic or tricuspid valve (this can be prevented by pull back with a deflated balloon), thrombo-emolism of pulmonary infarction. In 0.03-0.2% a pulmonary rupture is described. | |||