Cathlab hemodynamics – 1

pressures, waveforms ,cardiac

output and resistance

Dr .Lakshmi Gopalakrishnan
Southern Railway Hospital
 HEMODYNAMICS IN CARDIAC
CATHETERIZATION
• PRESSURE MEASUREMENTS

• MEASUREMENT OF FLOW

• VASCULAR RESISTANCE

• Principle of Ohm’s Law : Q = ∆P / R

 Pressure recording system
• Consists of catheter , transducer, amplifier and
recorder

• Must meet :
 amplitude linearity
 adequate frequency response
 phase linearity
 calibration of transducer over range of
amplitudes,and a plot gives linear
relationship
 optimal damping
Frequency response and optimal damping
 Pressure Measurement systems

• Fluid filled catheters

• Micromanometer catheters
 Transducers –
to be calibrated against a known pressure, “ zeroed” placing
at mid chest level and balanced ( zero all the transducers being used
simultaneously) immediately prior to obtaining simultaneous
recordings
 Fluid filled system - contd
Sources of error

• Distortion of the output signal due to

frequency response and damping
charecteristics
optimal damping achieved by short, wide-bore ,
non compliant catheter directly connected to
transducer with no air bubbles in the liquid .This
achieves frequency response close to output –to-
input ratio of 1.

• catheter whip artifact, end-pressure

artifact, catheter impact artifact,
catheter tip obstruction
 Pressure measurement – micromanometer
system

• Advantages include higher natural frequencies, optimal

damping characteristics, no whip artifacts

• Less distorsion of waveforms, lack the 30- 40 msec

delay

• Commercially available ones have both end hole and

side holes for over the wire use and angiography and ones
with two tip transducers for pressure gradients

Disadvantages - expense, fragility, added procedure time

• Used for research work only.

Fluid filled catheter vs micromanometer catheter
 Normal pressure waveforms
Atrial waveforms
Right atrium a wave highest
Pre – a wave pressure
a wave
x descent
x’ descent
v wave
y descent
Left atrium v wave highest , pressure higher
Pulmonary capillary wedge, similar to LA
waveform, damped, delayed
 Respiratory variation
• During spontaneous respiration intrathoracic
pressure falls in end expiration by 3-4 mmhg and
end-inspiration by 7-8 mmhg

• This reduces the RA, LA, Aortic pressures and

hence underestimates

• All recordings in end expiration since it closely

resembles the atmospheric pressure
 Atrial waveforms- important points

• Shows two positive waves ‘a’ atrial and ‘v’ ventricular

and negative waves x’ and y descents

• ‘a’ wave is prominent with abnormalities of reduced

RV,LV compliance

• ‘v’ wave is prominent in AV valve regurgitation

• X’ and y descents are diminished in pericardial

tamponade

• X’ and y descents are accentuated in constriction

and restrictive diseases
 Ventricular pressure waveform
Consists of

• Small rapid-filling wave

• slow filling wave

• ‘a’ wave co-incident with atrial systole

• Ventricular systolic pressure wave

Pressures reported are

early diastolic pressure
End- diastolic pressure
peak systolic pressure
Ventricular pressure waveform -- diastole
Ventricular pressure waveform - systole
 Arterial pressure waveforms

• Rapidly rising systolic pulse wave

• ‘ incisura’

• End diastolic pressure

• Measured central aortic pressure wave is a conjugate of both forward

and reflected waves
factors that augment pressure wave reflections
vasoconstriction
heart failure
hypertension
ilio femoral obstruction
valsalva – after release
Aortic pressure waveform
Central aortic pressure waveform a conjugate of forward & reflected waves
Aortic pressure waveforms as a function of distance from the Aortic valve
Aortic pressure waveform before & after occlusion of femoral –major increase
from augmentation of reflected waves
Pulmonary artery pressure waveform
 Cardiac output
• Quantity of blood supplied to systemic circulation
per unit time in L / min

• Determined by preload, heart rate and myocardial

contractility

• Cardiac index = CO in L / min / m2 BSA

• Other variables like age, posture, temperature

considered while interpreting CO
 Determination of CO - Technique
• Fick’s oxygen method
• Thermodilution method
• Fick’s principle- states that the total uptake or release of any
substance by an organ is the product of blood flow to the organ
and the art- venous concentration difference of the substance
• CO = O2 consumption / AV Oxygen difference

• CO = 130 x BSA
(Sa O2 – Sv O2) x Hb x 1.36 x 10

• Error in this method -10%

Most accurate in low output states and conditions with irregular HR like
AF and V bigeminy
 Thermodilution method
• Injection of 10ml of cold saline in the Right atrium
• Measure the temp change in the PA and a transient drop in
temp occurs
• Curve plotted of the temp of PA vs time
• Has a smooth up slope and a more gentle decline
• Area under the curve is inversely proportional to the CO

CO = CC x (Tb – Ti).
Where cc is the computation constant, Tb the blood temperature and
Ti the injectate temperature
• Severe TR is a contraindication to use of the method
Error with this method 5- 20%

• Most accurate in high output states and less accurate in low

output states
Thermodilution curves – PA temperature vs time
 Vascular resistance
In clinical practice Ohm’s law : Q = ∆P / R is used to calculate resistance

• Systemic vascular resistance = AO mean - RA mean

QS
• Pulmonary vascular resistance = PA mean - LA mean
QP

pressures are in mmhg , flow in litres per min and resistance in Hybrid
resistance unit or Wood’s unit expressed as mmhg / litre/ min

• Wood units can be converted to metric units by conversion factor 80

expressed as dynes.sec.cm -5

• Vascular resistance is normalized for BSA giving a Resistance Index.

SVRI = Ao(mean) – RA(mean) 80
______________________
CI
Where CI is Cardiac Index. Thus SVRI = SVR x BSA
NORMAL VALUES FOR VASCULAR RESISTANCE
Systemic vascular resistance 1170 + 270 dynes – sec – cm -5

Systemic vascular resistance index 2130 + 450 dynes – sec – cm-5 m2

Pulmonary vascular resistance 67 + 30 dynes – sec – cm-5

Pulmonary vascular resistance index 123 + 54 dynes – sec

– cm-5 m2
Thank you for your kind attention !