This document discusses how to assess intra-cardiac pressures using echocardiography. It provides normal reference values for right atrium, right ventricle, pulmonary artery, left atrium, and left ventricle pressures. It then explains how to estimate pressures in each chamber using Doppler measurements of pressure gradients across valves along with simplified Bernoulli's equation. Specific techniques are presented for calculating pressures in the right atrium, right ventricle, pulmonary artery, left atrium, and left ventricle under normal and abnormal cardiac conditions.

1. ECHO Hemodynamics
Assessment of Intra-Cardiac Pressures
Presented by Avneesh Raj

2. Doppler Shift

3. Normal Intra-Cardiac Pressures (in mm Hg)
Right Atrium = 0-4
Right Ventricle = 25/4
Pulmonary Artery = 25/10
Left Atrium = 8-10
Left Ventricle = 120/10
Aorta = 120/80

4. Simplified Bernoulli’s Equation
• Based on the law of conservation of mass.
• Energy per unit volume before = Energy per unit volume after
• P + ρgh + ½ ρv2 = constant (main equation)
Pressure Gradient = 4 V2

5. RA Pressure
• Done by IVC Dimensions
• Normal values of IVC is 2.1 cm or less with a collapse of more than
50% with a sniff.
RAP mm Hg IVC size Collapse
Normal 3 Normal Normal
Intermediate 8 Normal Abnormal
Intermediate 8 Abnormal Normal
High 15 Abnormal Abnormal

6. RV Systolic Pressure
•RV Systolic Pressure = TR Gradient + RAP
• TR gradient is the difference between RA and RV pressure (during
systole)
TR gradient will be calculated by simplified Bernoulli’s equation
An alternative ( non TR based) way of estimating RV systolic pressure is
RV Systolic Pressure = LV Systolic Pressure – VSD gradient

7. RV Diastolic Pressure
• In the absence of TS :
RV Diastolic pressure = RA Pressure
• In the presence of TS:
RV Diastolic Pressure = RA Pressure – TS Gradient

8. PA Systolic Pressure
•In the absence of PS:
PA Systolic Pressure = RV Systolic Pressure
= TR Gradient + RA Pressure
•In the presence of PS:
PA Systolic Pressure = RV Systolic Pressure – PS Gradient

9. PA Diastolic Pressure
PA Diastolic Pressure =
+ RA pressure
PR end Diastolic gradient
If there is no TR or PR then you can use RVOT Acceleration Time
Mean PAP = 79 – (0.45 x AcT)
Mahan’s Formula

10. Calculation of LA Pressure
• This is when there is no MS, MR or Prosthetic valve
LAP = 1.24 [ ( E/e`) + 1.9]
Simplifying this equation
LAP = ( E/e`) + 4
• If ( E/e`) = 8 then LA pressure is normal
• If ( E/e`) ≥ 15 then LA pressure is high

11. Calculation of LA Pressure
• This is when there MS, MR or Prosthetic valve
LAP = LV Diastolic pressure + MV mean gradient

12. Estimating LA pressure by ( E/e`) may be
inaccurate in:
•Mitral Stenosis
•Mitral annular Calcification
•Prosthetic Mitral Valve
•Mitral Regurgitation
•Diffuse severe LV dysfunction

13. LV Systolic Pressure
• In pts without Aortic Valve Disease:
LV systolic pressure = Systolic BP
• In pts with AS or LVOT obstruction
LV systolic pressure = systolic BP + 70% of the gradient

14. LV Diastolic Pressure
• In pts without MS:
LV diastolic pressure ≈ LA pressure
• In pts with AR:
LV end diastolic pressure = diastolic BP – AR gradient

15. Thank you 