Mitral Valve and Right Heart and 12-Lead EKG Interpretation

Measurements performed with PW

Measurements performed with CW

what side of the baseline is flow?

which side of the baseline is regurgitation?

what is ischemia?

• initial lack of oxygen

• restricted lack of blood flow causing oxygen deprivation

• potentially reversible

what is infarction?

• tissue death from prolonged hypoxia

• permanent tissue death

• irreversible damage

how do you evaluate ischemia on an EKG?

• ST segment: depression and elevation

• T wave: peaking, flattening, and inversion

• Q wave: deepening or widening of Q wave and a loss of the R wave

what does this EKG show?

• ST elevation

what does this EKG show?

• ST depression

what does this EKG show?

• Tall, peaked T wave

what does this EKG show?

• inverted T wave

what does this EKG show?

• deep Q wave with inverted T wave

what does this EKG show?

• deep Q wave with loss of the R wave

what can be identified on EKG?

• information about heart’s electrical status

• proof of what happened to heart during recording

what can’t be identified on EKG?

• no information about heart’s mechanical pump

• cannot prove what will happen to heart in the future

what is RVSP?

• RV systolic pressure

• noninvasive estimate of how much pressure the lungs’ blood vessels are generating

• often points towards pulmonary hypertension

• use the simplified bernoulli equation to calculate TR pressure gradient

RVSP formula

= 4 (TR peak)² + RAP

step by step calculation of RVSP

• obtain TR jet via A4C/parasternal

• use CW to measure peak TR velocity

• square the velocity and multiple by 4

• now you have RV-RA gradient

• estimate RAP from IVC

• add RAP to gradient to get RVSP

measurements needed for RVSP

• TR peak velocity (CW) (gets pressure gradient between RV and RA)

• right atrial pressure (estimated from IVC size)

what is the IVC size of a RAP of 3 mmHg?

• less than 2.1 cm

what is the IVC size of a RAP of 8 mmHg?

• intermediate

what is the IVC size of a RAP of 15 mmHg?

• greater than 2.1 cm

how is 2D mode used for RVSP?

• identifies anatomy (IVC size) and TR jet location

how is color doppler mode used for RVSP?

• visualizes regurgitant jet

• aliasing jet

how is CW mode used for RVSP?

• measures high velocities

• measures TR peak velocity

how is M-Mode mode used for RVSP?

• IVC dynamics

what does RVSP tell us?

• pulmonary artery pressure (indirectly)

• right heart afterload (how hard the RV has to pump to the lungs)

why is RVSP important?

• screening for pulm HTN, lt heart disease, lung disease

• monitors progression of pulmonary hypertension

• assesses risk

• guides further testing