07 Wiggers And Venous

Wigger's

[_](Wigger's diagram, normal)..

  • LA: lowest pressure of the three curves

  • MV: always start looking here, beginning of systole, rise of LV pressure. When LV higher than LA, pushes MV close

  • MV - AV: pressure rises but no blood flowing out of LV, isovolemic contraction

  • AV: LV pressure > aorta, pop AV open.

  • AV - AV: As blood gets pushed out of aorta, LV pressure just a bit higher than aorta

  • AV close: LV pressure falls below aorta pressure, AV closes

  • AV close - MV open: isovolumetric relaxation

  • MV open: LV pressure < LA pressure, diastolic filling

  • MV close to AV close = systole

  • AV close to MV close = diastole

  • MV close: S1, QRS (ventricular depolarization), initiation of systole

  • AV close: S2

Pathologic

[_](Wigger's diagram, aortic stenosis)..

  • LV pressure rises very high, above aortic pressure, aortic stenosis

[_](Wigger's diagram mitral stenosis)..

  • LA pressure already higher than LV in all systole and diastole, mitral stenosis

  • LA pressure has to rise higher than usual to push through the valve

[_](Wigger's diagram, mitral regurg)..

  • normally: LA pressure goes up a little during systole

  • diseased: LA pressure goes up very high during systole, filling atrium in systole, mitral regurg

[_](Wigger's diagram aortic regurg)..

  • aortic pressure drains down much more rapidly, wide pulse pressure, low diastolic pressure, blood leaking out of aorta

  • aortic regurg

Venous Tracing

[_](Venous tracing normal, TV open and close when, RV filling and contraction when. Corrsponding Wigger's diagram)..

  • JVP = RA pressure, no valve

  • pulmonary vein pressure = LA pressure

  • a: RA contraction, myocardium squeezing blood, peak at a

  • atrial relaxation follows as blood spills into RV

  • c: tricuspid closes, causing bump in pressure, then atrium continues to relax, x descent

  • pressure starts to climb again with atrial filling

  • v: tricuspid valve opens, blood spills to RV, y descent

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  • what happens in RV

  • beginning of RV contraction closes TV

  • y: TV opens, blood leaves RA to go to RV

  • QRS (ventricle contract) right before C wave, then S1 from tricupid closing

  • V wave just after S2 (closure of aortic valve)

Pathologic

_..

  • closed tricuspid valve, can see in pt's neck

  • no atria contraction

  • v wave after v wave with no a wave

  • RV contraction, shoots blood right cross into RA

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