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Right heart catheterization: Difference between revisions
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''Normal RA pressure = 6 mmHg (3 mean)'' | ''Normal RA pressure = 6 mmHg (3 mean)''<br/> | ||
Higher RA pressure in RV infarction, pulmonary hypertension, left to right shunts, tricuspid regurgitation, tamponade, pericarditis constrictiva, restrictive cardiomyopathy. | Higher RA pressure in RV infarction, pulmonary hypertension, left to right shunts, tricuspid regurgitation, tamponade, pericarditis constrictiva, restrictive cardiomyopathy. | ||
''Abnormal right atrium pressure waves'' | ''Abnormal right atrium pressure waves''<br/> | ||
#Elevated a wave: tricuspid stenosis, decreased ventricular compliance due to ventricular failure, pulmonic valve stenosis | #Elevated a wave: tricuspid stenosis, decreased ventricular compliance due to ventricular failure, pulmonic valve stenosis | ||
#Absent a wave: atrial fibrillation | #Absent a wave: atrial fibrillation | ||
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a= atrial contraction (corresponding with a wave of RA curve) (25% of RV filling)]] | a= atrial contraction (corresponding with a wave of RA curve) (25% of RV filling)]] | ||
''Normal RV pressure = 25 / 4 mmHg'' | ''Normal RV pressure = 25 / 4 mmHg''<br/> | ||
When there are no abnormalities in the right heart: CVP = RA pressure = RVEDP. | When there are no abnormalities in the right heart: CVP = RA pressure = RVEDP. | ||
The pressure curve consists of a fast upstroke, a rounded top, directly after the QRS complex. | The pressure curve consists of a fast upstroke, a rounded top, directly after the QRS complex. | ||
Higher RV pressure in pulmonary hypertension, pulmonic valve stenosis, significant ASD or VSD, pulmonary embolism (in acute pulmonary embolism mostly not above 40-50mmHg). | Higher RV pressure in pulmonary hypertension, pulmonic valve stenosis, significant ASD or VSD, pulmonary embolism (in acute pulmonary embolism mostly not above 40-50mmHg). | ||
''Abnormal right ventricle pressure waves'' | ''Abnormal right ventricle pressure waves''<br/> | ||
#Systolic pressure reduced: hypovolemia, cardiogenic shock, tamponade | #Systolic pressure reduced: hypovolemia, cardiogenic shock, tamponade | ||
#Elevated end diastolic pressure: cardiomyopathy, RV ischemia and infarction, RV failure, tamponade, pericarditis constrictiva | #Elevated end diastolic pressure: cardiomyopathy, RV ischemia and infarction, RV failure, tamponade, pericarditis constrictiva | ||
#Decreased end diastolic pressure: tricuspid stenosis | #Decreased end diastolic pressure: tricuspid stenosis | ||
#Dip-and-plateau in constrictive pericarditis and restrictive myopathies | #Dip-and-plateau in constrictive pericarditis and restrictive myopathies | ||
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== Pulmonary artery pressure == | == Pulmonary artery pressure == | ||
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ed= end-diastolic pressure]] | ed= end-diastolic pressure]] | ||
''Normal PA pressure 25 / 9 mmHg (mean 15)'' | ''Normal PA pressure 25 / 9 mmHg (mean 15)''<br/> | ||
''Abnormal pulmonary artery pressure waveforms'' | ''Abnormal pulmonary artery pressure waveforms''<br/> | ||
#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 | #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 | #Reduced pulce pressure: RV ischaemia or infarction, pulmonary embolism, tamponade | ||
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y= passive filling of the LV after mitral valve opening]] | y= passive filling of the LV after mitral valve opening]] | ||
''Normal PCWP pressure range = 4-12 mmHg (mean 9) | ''Normal PCWP pressure range = 4-12 mmHg (mean 9)<br/>'' | ||
''When there is no obstruction between left atrium and left ventricle: PCWP = LA pressure = LVEDP. | 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. | A true wedge pressure can be measured only in the absence of flow”, meaning with a vessel closed for flow by a balloon. | ||
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*Respiratory failure (hypoxemia and pulmonary vasoconstriction) | *Respiratory failure (hypoxemia and pulmonary vasoconstriction) | ||
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The LVEDP is higher than the wedge in: | The LVEDP is higher than the wedge in: | ||
*Diastolic dysfunction, positive end-expiratory airway pressure | *Diastolic dysfunction, positive end-expiratory airway pressure | ||
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*Aortic regurgitation (early closure mitral valve) | *Aortic regurgitation (early closure mitral valve) | ||
''4.8 Abnormal PCWP pressure'' | ''4.8 Abnormal PCWP pressure''<br/> | ||
#Low mean pressure: hypovolemia | #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 mean pressure: intravascular overload, LV failure caused by myocardial disease, systemic hypertension or valvular disease (MS, AoS, AoR), pericardial effusion with tamponade | ||