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CO - RELATION WITH ECG

INTRA CARDIAC PRESSURES. CO - RELATION WITH ECG. ASHOK MADRAS MEDICAL MISSION CHENNAI. www.anaesthesia.co.in anaesthesia.co.in@gmail.com. What is the importance of the Intra cardiac pressures ?.

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CO - RELATION WITH ECG

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

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

  3. PURPOSETo 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 20 RA -20 NORMAL RA PRESSURE : AVG(mmHg) RANGE(mmHg) a wave - 6 2-7 v wave - 5 2-7 mean - 3 1-5

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

  8. PCW AND PA PRESSURE TRACING 40 PCW PA NORMAL PA AVG(mmHg) RANGE(mmHg) Peak Systolic 25 15-30 End diastolic 9 4- 12 Mean 15 9-19 NORMAL PCW AVG(mmHg) RANGE(mmHg) Mean 9 4-12

  9. Lt HEART PRESSURES AO LV 100

  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 100 NORMAL AO PRESSURE AVG(mmHg) RANGE (mmHg) PEAK SYSTOLIC 130 90-140 END DIASTOLIC 70 60- 90 MEAN 85 70-105

  12. LEFT VENTRICULAREND DIASTOLIC PRESSURE( LVEDP )

  13. LV PRESSURE LV 100

  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 LV 100

  18. LV PRESSURE IN AF LV - 100

  19. PULMONARY CAPILLARY WEDGEPRESSURE

  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 40 PCW PA

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

  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. LV & PCWP Measurement R wave - ECG

  28. SIMULTANIOUS LV & LA PRESSURES LA & LV 40

  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 POSITIONPCW & LV PCW LV

  32. CATHETER POSITIONLA & LV LA LV

  33. HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

  34. LV TO AO PULL BACK GRADIENT

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

  36. ECTOPIC GRADIENT LV & AO 200

  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

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