Abnormal Pressures

Lancashire & South Cumbria Cardiac Network

Abnormal Left Heart Pressure Findings – Valvular

Disease • Aortic stenosis

• Aortic Regurgitation

• Mitral stenosis

• Mitral Regurgitation

Stenosis -Pressure Gradient

• Used to assess the presence and severity of valvular stenosis

• Measured during the part of the cardiac cycle when the valve assessed should be fully open

Aortic Stenosis

• Measured during ventricular systole – when Aortic valve should be fully open

• Therefore measure of systolic pressure

• Gradient – difference in systolic pressures across Aortic valve

• between LV and Aorta

Measurement

• LV to Ao Pullback

• LV & Ao superimposed

Peak measurement

Mean measurement

Regurgitation

• Used to assess the presence and severity of valvular incompetence

• Measured during the part of the cardiac cycle when the valve assessed should be fully closed

Aortic Regurgitation

• Measured during ventricular diastole –when Aortic valve should be fully closed

• Therefore it is a measure of diastolic pressure

• Seen as a low diastolic Aortic pressure measurement

Measurement

• Seen on aortic pressure trace

• Can also lead to an increased LVEDP

Mitral stenosis• Measured during ventricular diastole - when

Mitral Valve should be fully open

• Therefore it is a measure of diastolic pressure

• Gradient – difference in diastolic pressures across mitral valve

• Between LV & LA (PCWP)

Measurement

• Increase PCWP – ‘a’ wave > 12 mmHg

• Gradient seen between PCWP & LVEDP

Peak measurement

Mean measurement

Mitral Regurgitation

• Measured during ventricular systole- when Mitral valve should be fully closed

• Therefore it is a measure of systolic pressure

• Seen as a high ventricular systolic measurement (V- wave) on the LA (PCWP) trace

Measurement

• PCWP trace elevated

• ‘v’ wave > 12 mmHg

Abnormal Right Heart Pressure Findings

• Pulmonary Stenosis

• Pulmonary Regurgitation

• Tricuspid Stenosis

• Tricuspid Regurgitation

• Apply the same principles to the corresponding valve on the right side

• Assess the valve during the appropriate part of the cardiac cycle

Pulmonary Stenosis• Measured during ventricular systole – when

Pulmonary valve should be fully open

• Therefore measure of systolic pressure

• Gradient – difference in systolic pressures across Pulmonary valve

• Between RV & PA

Measurement

• PA to RV pullback

• PA & RV superimposed

Pulmonary Regurgitation

• Pulmonary Regurgitation

• Measured during ventricular diastole –when Pulmonary valve should be fully closed

• Therefore it is a measure of diastolic pressure

• Seen as a low diastolic pulmonary pressure measurement

Measurement

• Seen on PA trace

• Can lead to an elevated RVEDP

Tricuspid stenosis• Measured during ventricular diastole - when

Tricuspid Valve should be fully open

• Therefore it is a measure of diastolic pressure

• Gradient – difference in diastolic pressures across Tricuspid valve

• Between RV & RA

Measurement

• Elevated ‘a’ wave seen on RA trace

• Gradient seen between RA & RVEDP

Tricuspid Regurgitation

• Measured during ventricular systole- when Tricuspid valve should be fully closed

• Therefore it is a measure of systolic pressure

• Seen as a high systolic measurement (V- wave) on the RA trace

Measurement

• Large ‘v’ wave seen on RA trace‘

Summary

• Aortic/Pulmonary Stenosis – ventricular systole – elevated LV/RV pressure

• Aortic/Pulmonary Regurgitation –ventricular diastole – drop Ao/PA diastolic pressure

Summary

• Mitral/Tricuspid Stenosis – ventricular diastole – elevated LA/RA pressure

• Mitral/Tricuspid Regurgitation – ventricular systole – elevated LA/RA pressure(V wave)