Describe the Pressure Tracings

See the figure shown and answer the following questions

a)      Describe the aortic pressure tracing

b)      Describe normal Atrial pressure tracing

c)       Describe atrial pressure tracing in tricuspid regurgitation

d)      Effect of Tamponade on atrial pressure tracing

Answers:

a.      When aortic valve opens, pressure increases as blood flows into the aorta and reaches its maximum. Pressure falls as blood flows out of aorta and aortic valve closes
 

b.      " a " wave corresponds to right Atrial contraction and its peak demarcates the end of atrial systole. The " c " wave corresponds to right ventricular Contraction causing the tricuspid valve to bulge towards the RA. The " x " descent follows the 'a' wave and corresponds to atrial relaxation and rapid atrial filling due to low pressure. The " v " wave corresponds to Venous filling when the tricuspid valve is closed and venous pressure increases from venous return . The " y " descent corresponds to the rapid emptying of the atrium into the ventricle following the opening of the tricuspid valve.


c.       In TR there is increased right atrial pressure. Blunted x descent, prominent v wave, steep y descent and ventricularization of right atrial pressure.


d.      In cardiac tamponade there is diastolic equalization of pressures (RAP = RV diastolic pressure = PCWP). Increased right atrial pressure, right ventricular pressure and PCWP. Blunted y descent, prominent x descent on RA tracing

Reference:

Chapter 60, page 985 – Right Heart catheterization - Manual of Cardiovascular Medicine Fourth Edition - Brian P. Griffin MD FACC