Heart Pressures

Primary Pulmonary HTN

Rare but fatal

Secondary Pulmonary HTN

Left heart disease

COPD

Thrombotic events

Vascular disease

Symptoms of Pulmonary HTN

RV overload = failure

Weakness

Syncope

Cor Pulmonale

Changes in RV size and function due to Pulmonary HTN

-> RV hypertrophy, dilation, decreased function

Results in poor oxygen perfusion and systemic venous congestion

Estimating Heart Pressures by Echo

Peak velocities of regurgitant flow shunts estimate pressure differences between two chambers

Velocities are directly related to the pressure across that valve

Use Bernoulli equation (4V^2)

Increased pulmonary/right heart pressures indicate...

Increased left heart disease

Estimating RA Pressure

IVC collapse

= RVDP

Normal RA Pressure & IVC

3 mmHg

< 2.1 cm with >50% collapse

Estimating RVSP

Determined by gradient across a systolic lesion

= PASP

Normal RVSP

≤ 34 mmHg

Estimating RVSP by TR

TR velocity

RA pressure

Estimating RVSP by VSD or PDA

VSD or PDA velocity

Systolic BP

Estimating PADP

End-diastolic PI velocity

RA pressure

Estimating mPAP (wedge pressure)

Peak PI velocity or TR VTI (mean gradient)

RA pressure

Normal mPAP

≤ 20 mmHg

Estimating LA Pressure

Peak MR velocity

Systolic BP

Estimating LV Systolic Pressure

Peak MR velocity

LA pressure

Estimating LV ED Pressure

End-diastolic AI velocity

Diastolic BP

Indication of Elevated LV ED Pressure

M-mode MV B-bump

Correlations Between Heart Pressures

LA pressure = LVDP = PA ED = mPAP