07 Wiggers and Venous

  • LA: lowest pressure of the three curves

  • MV: always start looking here, beginning of systole, rise of LV pressure. When LV higher than LA, pushes MV close
  • MV - AV: pressure rises but no blood flowing out of LV, isovolemic contraction
  • AV: LV pressure > aorta, pop AV open.
  • AV - AV: As blood gets pushed out of aorta, LV pressure just a bit higher than aorta
  • AV close: LV pressure falls below aorta pressure, AV closes
  • AV close - MV open: isovolumetric relaxation
  • MV open: LV pressure < LA pressure, diastolic filling
  • MV close to AV close = systole
  • AV close to MV close = diastole

  • MV close: S1, QRS (ventricular depolarization), initiation of systole
  • AV close: S2

Pathologic

  • LV pressure rises very high, above aortic pressure, aortic stenosis

  • LA pressure already higher than LV in all systole and diastole, mitral stenosis
  • LA pressure has to rise higher than usual to push through the valve

  • normally: LA pressure goes up a little during systole
  • diseased: LA pressure goes up very high during systole, filling atrium in systole, mitral regurg

  • aortic pressure drains down much more rapidly, wide pulse pressure, low diastolic pressure, blood leaking out of aorta
  • aortic regurg

Venous Tracing

  • JVP = RA pressure, no valve
  • pulmonary vein pressure = LA pressure

  • a: RA contraction, myocardium squeezing blood, peak at a
  • atrial relaxation follows as blood spills into RV
  • c: tricuspid closes, causing bump in pressure, then atrium continues to relax, x descent
  • pressure starts to climb again with atrial filling
  • v: tricuspid valve opens, blood spills to RV, y descent
  • 1957 jugular venous pressure youtube

  • what happens in RV
  • beginning of RV contraction closes TV
  • y: TV opens, blood leaves RA to go to RV

  • QRS (ventricle contract) right before C wave, then S1 from tricupid closing
  • V wave just after S2 (closure of aortic valve)

Pathologic

  • closed tricuspid valve, can see in pt's neck

  • no atria contraction
  • v wave after v wave with no a wave

  • RV contraction, shoots blood right cross into RA