This document discusses hemodynamic principles and waveform analysis from cardiac catheterization. It provides an overview of normal and abnormal pressure waveforms from the right atrium, pulmonary artery, left ventricle, and aorta. Key points include how respiration and different disease states can impact pressure tracings. The document also outlines the components and uses of the Swan-Ganz catheter for measuring pressures in the right heart and pulmonary circulation.

1. WAVEFORM AND BASIC HEMODYNAMIC
BUI GIO AN.
CARDIOLOGY DEPARTMENT.
INTERVENTIONAL CATHLAB.

2. BASIC HEMODYNAMIC PRINCIPLES
‖

3. FLOW: LAMINAR OR TURBULENT
Flow in straight,
nonbranching tubes.
EX: Blood past the vascular wall
Fluid particles from djacent
layers become mixed.
Blood past the stenotic vascular wall

4. POISEUILLE’S LAW AND TURBULANT
In turbulent flow
Resistance ⇧⇧⇧.
Larger pressure differences are required to maintain flow

5.  50% in the venous system.
 15% within the heart.
 20% within pulmonary circulation
 10% in arteries.
 5% in arterioles and capillaries
VEIN AND ARTERY SYSTEM
Venous system can absorb a large amount of volume

6. PRESSURE AND VELOCITY OF
FLUID IN A CLOSED SYSTEM
⇩
⇩
⇩
⇩

7. RESISTANCE
Resistance increases
Resistance decreases

8. RELATIONSHIP: P ∼ AREA∼ V

9. NORMAL HEMODYNAMIC VALUES

10. RIGHT HEART CATHETERIZATION
THE PA CATHETER
• Swan–Ganz catheter or right heart catheter.
• 100–110 cm long and has either 3 or 4
lumens.
• Information about:
– Right ventricular preload: RA.
– Left ventricular preload: PCWP.
– Afterload :
• Systemic vascular resistance.
• Pulmonary vascular resistance.

11. THE PA CATHETER
RA
PA
PCWP
RV
 PA catheter needs to be “zeroed” at the level of the RA.
 Avoid narrow tubing.
 Eliminate any air bubbles.
 Proper pressure scale.
 Interpreted in conjunction with an ECG.
 Effects of respiration have to be identified.

12. WAVEFORM: RA
Positive atrial (A)
Ventricular (V) waves
X and Y descents

13. MECHANICAL EVENTS OF THE CARDIAC CYCLE
A wave
⇧
X descents
C wave
V wave
Y wave
⇩
⇩
⇩

14. ABNORMAL RIGHT ATRIAL PRESSURE TRACINGS
Prominent Blunted
A wave A–V dissociation.
Decreased ventricular compliance.
Tricuspid stenosis.
Pulmonary stenosis.
Atrial arrhythmia.
X descent Tamponade.
RV ischemia.
Atrial septal defect.
Tricuspid regurgitation.
V wave Tricuspid regurgitation. Tamponade
Hypovolemia
Y descent Constrictive pericarditis.
Restrictive cardiomyopathy.
RV failure.
Tamponade.
Tricuspid stenosis.

15. RA: ABNORMAL A WAVE
PROMINENT A WAVE

16. “Prominent” right-sided V wave was defined as:
1.V wave >15mmHg
2.A difference between V wave and mean RA pressure >5mmHg
3.Or a ratio of V wave to mean RA pressure >1.5.
RA: PROMINENT V WAVE

17. Pressure tracings from a patient with severe tricuspid regurgitation
TRICUSPID REGURGITATION

18. CONSTRICTIVE PERICARDITIS
AND RESTRICTIVE CARDIOMYOPATHY.
DEEP Y WAVE

19. CARDIAC TAMPONADE
1. Prominent X
2. Small V and Y

20. WAVEFORM: PCWP
NORMAL: V>A
The V wave on PCWP tracing corresponds to:
1.T wave on ECG and
2.Descent of pressure tracing on LV recording

21. PCWP: abnormal V wave
1. V wave >2x mean PCWP: suggestive of severe MR
2. V wave >3x mean PCWP: diagnostic of severe MR
3. Absence of significant V waves does not exclude
significant MR.
4. When large V waves are present, trough of Y descent is
better predictor of LVEDP than is mean PCWP.
5. V waves are affected by arterial systolic blood pressure
(i.e. ventricular afterload).

22. PCWP: ABNORMAL V WAVE
A wave
V wave
PCWP tracing in a patient with severe MR showing a V wave
When large V waves are present, trough of Y descent is better predictor of LVEDP
than is mean PCWP
MEAN PCWP
30%

23. PCWP AND LV WAVE: MV STENOSIS
PCWP and LV pressure tracings in a patient
with mitral stenosis and mitral regurgitation

24. WAVEFORM: RV
S: SYSTOLIC
D :DIASTOLIC
E: END-DIASTOLIC

25. WAVEFORM: RV
VENTRICULAR DIASTOLE
RF: The early or rapid filling phase
Slow filling (SF) phase
Right atrial systole (A wave)
Right ventricular end-diastolic pressure (EDP)

26. WAVEFORM: PA
1. DIASTOLIC WAVE
2. NEARLY THE SAME WITH AORTA WAVE.
3. DICROTIC NOTCH.

27. WAVEFORM: AORTA
Closure of the aortic valve
Aortic valve opens
Anacrotic limb
Anacrotic shoulder
Dicrotic limb
3 COMPONENT

28. EFFECT OF RESPIRATION ON AORTIC PRESSURE
INSPIRATION
1. Augmented systemic venous return to right-sided chambers .
2. Decreased venous return to left-sided chambers.
3. Slight decrease in systolic blood pressure (approximately 5mmHg).
<10mmHg
18–22mmHg
Patient with pleural effusions

29. AORTIC PRESSURE IN TAMPONADE
INSPIRATION
30mmHg

30. AORTIC PRESSURE IN A HYPOVOLEMIC PATIENT
CHANGE IN WAVE FORM AFTER FLUID INFUSION
PEAK
TIME

31. LEFT VENTRICULAR DIASTOLIC WAVEFORM
Severe ischemic cardiomyopathy Aortic insufficiency

32. LEFT VENTRICULAR DIASTOLIC WAVEFORM
Constrictive pericarditis
Dip and plateau configuration
Hypertrophic cardiomyopathy
Elevated end diastolic pressure

33. LEFT VENTRICULAR DIASTOLIC WAVEFORM
• ischemic cardiomyopathy ((e); note the
elevated end diastolic
• pressure and accentuated A wave
Restrictive cardiomyopathy
Dip and plateau configuration
Elevated end diastolic pressure and
accentuated A wave
Ischemic cardiomyopathy

34. LEFT VENTRICULAR DIASTOLIC WAVEFORM
PERICARDIAL TAMPONADE
Before pericardiocentesis. After pericardiocentesis

35. THANK YOU