07 Wiggers and Venous

• 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

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

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

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

Venous Tracing

• 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
• 1957 jugular venous pressure youtube

• 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