Sunday, July 20, 2014

Quiz #31: Answer

This RA trace was recorded in cath lab under endotracheal general anesthesia.
Question: Which wave is the taller one, a wave or v wave?

Answer: a wave (See labelled images below).

RA pressure trace consists of a, c, v waves and x, y descents.
a – atrial systole (occurs immediately after P wave. Note: electrical activity precedes mechanical activity). Dotted line helps to compare the P wave to the RA waveform.
c – bulging of tricuspid valve “cusps” during onset of ventricular systole. This will appear just after LV pressure trace crosses the atrial wave.
v – venous filling (occurs during atrial diastole which is ventricular systole). Therefore, v wave should coincide with ejection phase of ventricle as shown in LV trace or PA line trace.

(Click on the image to enlarge)
Additional images from the same patient - recorded with LPA pressure in one panel and with LV pressure in the other panel. Label indicates where c wave will be expected.



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