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 Pressure in Originating Chamber (OC)

Assume standard pressure in receiving chamber

RC pressure + 4V^2

Estimating Pressure in Receiving Chamber (RC)

Assume standard pressure in originating chamber

OC pressure - 4V^2

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

= 4(TR velocity)^2 + RA pressure

Estimating RVSP by VSD or PDA

= systolic BP - 4(VSD or PDA velocity)^2

Estimating PADP

= 4(end-diastolic PI velocity)^2 + RA pressure

Estimating mPAP (wedge pressure)

= 4(peak PI velocity)^2 + RA pressure

OR

= TR VTI/mean gradient + RA pressure

Normal mPAP

≤ 20 mmHg

Estimating LA Pressure

= Systolic BP - 4(peak MR velocity)^2

Estimating LV Systolic Pressure

= 4(peak MR velocity)^2 + LA pressure

Estimating LV ED Pressure

= Diastolic BP - 4(end-diastolic AI velocity)^2

Indication of Elevated LV ED Pressure

M-mode MV B-bump

Correlations Between Heart Pressures

LA pressure = LVDP = PA ED = mPAP