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