When working with Dr. Haycock there is a big chance that we are going to be tracing CVP line and he is going to be interpreting them. He is an NBE CCE diplomat therefore a guru in resuscitation and everything ultrasound. CVP is the very basis for atrial pressure. Learning CVP is a window and a precursor to understanding VExUS. Here is a quick review to CVP and hemodynamics in general.
Central Venous Pressure tracing is volume moving in and out of the RA or SVC represented as a filling pressure or is the surrogate for RA pressure around the cavoatrial junction (cava and atria); Measured using IJ or subclavian central venous catheter or PA catheter; Pressure tracing: A-C-X-Y-V. ACV(pressure): atrial filling pressure or volume moving in the RA. X Y(relaxation): Think X-Y-Zzzz. When you snooze you loose pressure. These tracing are descent or atrial relaxation, volume moving out of the RA.
pressure tracing:
A (late event in diastole; volume of blood moving into RA, compliance of RA),
This is your atrial contraction. Contraction to RA generates pressure to RA.
C (onset of ventricular systole; bowing of tricuspid valve into the RA; transient ^ atrial compliance; ^ atrial pressure; can merge with a wave during tachycardia),
The blip. Early Systole. Closed tricuspid valve but pressure from the RV systole pushes up against tricuspid valve- hence the bulging of TV into RA.
X (x descent; atrium relaxation; tricuspid valve descending towards apex of RV),
Mid systole. RA continues to relax.
V (late systolic event; filling of RA during ventricular systole; height is dependent on compliance of the RA and volume of blood filling the RA; large V wave is due to TV regurgitation or non compliance to RA; ^ volume + compliant RA + decrease V wave),
Rapid filling of blood into RA generates this pressure.
Y (Y descent; early diastolic event; early diastolic emptying of RA).
Early ventricular filling, early diastole (relaxation) and then back to A wave- the start of a new filling pressure.
A big thanks to our reference video where most of the information are extracted from: https://www.youtube.com/watch?v=x8ADwR2WBnY |
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