Pulmonary Wedge Pressure
Hemodynamics
Cardiac Output
Heart Failure
Vascular Resistance
Cardiac Catheterization
Pressure
Central Venous Pressure
Ventricular Pressure
Pulmonary Edema
Catheterization, Swan-Ganz
Prediction of life expectancy in patients with primary pulmonary hypertension. A retrospective nationwide survey from 1980-1990. (1/595)
Primary pulmonary hypertension (PPH) is a progressive disease of unknown etiology usually followed by death within 5 years after diagnosis. Although heart-lung or lung transplantation is now offered to patients with advanced PPH, adequate criteria assessing an accurate prediction of life expectancy in PPH has been difficult to establish. The aims of this study were to identify the characteristic features associated with a poor prognosis in patients with PPH, and to attempt to establish an individual prognostic index that predicts with great accuracy survival or death of PPH after one year, thereby helping to define criteria for patient selection for transplantation. In 1991, a retrospective nation-wide survey on PPH was conducted in Japan, and the clinical and cardiorespiratory variables of 223 PPH cases (female; 144, male; 79) in the period from 1980-1990 were obtained. The mean pulmonary arterial pressure (PPA) was 57.5+/-17.2 mm Hg (mean+/-SD), and the overall median survival time was 32.5 months since the first diagnostic catheterization. The characteristic features of 61 patients who died within one year of catheterization (Nonsurvivors group) were compared to 141 patients who survived one year or more from the time of catheterization (Survivors group). Among several clinical and cardiorespiratory variables, heart rate, PPA, right atrial pressure (PRA), stroke volume index (SI), pulmonary vascular resistance, and partial pressure of carbon dioxide (PaCO2) were significantly different between the two groups. As the independent factors, PPA, PRA, SI, and PaCO2 were selected for the multiple logistic analysis. Using a 0.7 probability cut-point to separate Nonsurvivors from Survivors, 84.6% of Nonsurvivors and Survivors could be correctly predicted from this logistic regression equation. Predictive equations like the present preliminary one can be used in the future to better assess life expectancy in patients with PPH in whom transplantation will be considered. (+info)Pulmonary capillary perfusion: intra-alveolar fractal patterns and interalveolar independence. (2/595)
Pulmonary capillary perfusion was analyzed from videomicroscopic recordings to determine flow switching characteristics among capillary segments in isolated, blood-perfused canine lungs. Within each alveolus, the rapid switching pattern was repetitive and was, therefore, nonrandom (fractal dimensions near 1.0). This self-similarity over time was unexpected in a network widely considered to be passive. Among adjacent alveoli, the relationship among the switching patterns was even more surprising, for there was virtually no relationship between the perfusion patterns (coefficients of determination approaching zero). These findings demonstrated that the perfusion patterns in individual alveolar walls were independent of their next-door neighbors. The lack of dependence among neighboring networks suggests an interesting characteristic: the failure of one alveolar-capillary bed would leave its neighbors relatively unaffected, a feature of a robust design. (+info)Effect of intensive therapy for heart failure on the vasodilator response to exercise. (3/595)
OBJECTIVES: The purpose of the study was to evaluate the lower extremity vascular responsiveness to metabolic stimuli in patients with heart failure and to determine whether these responses improve acutely after intensive medical therapy. BACKGROUND: Metabolic regulation of vascular tone is an important determinant of blood flow, and may be abnormal in heart failure. METHODS: The leg blood flow responses were measured in 11 patients with nonedematous class III-IV heart failure before and after inpatient medical therapy and in 10 normal subjects. Venous occlusion plethysmography was used to measure peak blood flow and total hyperemia in the calf after arterial occlusion and also after isotonic ankle exercise. Measurements were repeated following short-term inpatient treatment with vasodilators and diuretics administered to decrease right atrial pressure (18+/-2 to 7+/-1 mm Hg), pulmonary wedge pressure (32+/-3 to 15+/-2 mm Hg), and systemic vascular resistance (1581+/-200 to 938+/-63 dynes.s.cm(-5), all p < 0.02). RESULTS: Leg blood flow at rest, after exercise, and during reactive hyperemia was less in heart failure patients than in control subjects. Resting leg blood flow did not increase significantly after medical therapy, but peak flow after the high level of exercise increased by 59% (p = 0.009). Total hyperemic volume in the recovery period increased by 73% (p = 0.03). Similarly, the peak leg blood flow response to ischemia increased by 88% (p = 0.04), whereas hyperemic volume rose by 98% (p = 0.1). CONCLUSIONS: The calf blood flow responses to metabolic stimuli are blunted in patients with severe heart failure, and improve rapidly with intensive medical therapy. (+info)Combined effects of nitric oxide and oxygen during acute pulmonary vasodilator testing. (4/595)
OBJECTIVES: We compared the ability of inhaled nitric oxide (NO), oxygen (O2) and nitric oxide in oxygen (NO+O2) to identify reactive pulmonary vasculature in pulmonary hypertensive patients during acute vasodilator testing at cardiac catheterization. BACKGROUND: In patients with pulmonary hypertension, decisions regarding suitability for corrective surgery, transplantation and assessment of long-term prognosis are based on results obtained during acute pulmonary vasodilator testing. METHODS: In group 1, 46 patients had hemodynamic measurements in room air (RA), 100% O2, return to RA and NO (80 parts per million [ppm] in RA). In group 2, 25 additional patients were studied in RA, 100% O2 and 80 ppm NO in oxygen (NO+O2). RESULTS: In group 1, O2 decreased pulmonary vascular resistance (PVR) (mean+/-SEM) from 17.2+/-2.1 U.m2 to 11.1+/-1.5 U.m2 (p < 0.05). Nitric oxide caused a comparable decrease from 17.8+/-2.2 U.m2 to 11.7+/-1.7 U.m2 (p < 0.05). In group 2, PVR decreased from 20.1+/-2.6 U.m2 to 14.3+/-1.9 U.m2 in O2 (p < 0.05) and further to 10.5+/-1.7 U.m2 in NO+O2 (p < 0.05). A response of 20% or more reduction in PVR was seen in 22/25 patients with NO+O2 compared with 16/25 in O2 alone (p = 0.01). CONCLUSIONS: Inhaled NO and O2 produced a similar degree of selective pulmonary vasodilation. Our data suggest that combination testing with NO + O2 provides additional pulmonary vasodilation in patients with a reactive pulmonary vascular bed in a selective, safe and expeditious fashion during cardiac catheterization. The combination of NO+O2 identifies patients with significant pulmonary vasoreactivity who might not be recognized if O2 or NO were used separately. (+info)Atrial arrhythmia after surgical closure of atrial septal defects in adults. (5/595)
BACKGROUND: Atrial flutter and atrial fibrillation are causes of morbidity in adults with an atrial septal defect. In this study, we attempted to identify risk factors for atrial flutter and fibrillation both before and after the surgical closure of an atrial septal defect. METHODS: We searched for preoperative and postoperative atrial flutter or fibrillation in 213 adult patients (82 men and 131 women) who underwent surgical closure of atrial septal defects because of symptoms, a substantial left-to-right shunt (ratio of pulmonary to systemic blood flow, >1.5:1), or both at Toronto Hospital between 1986 and 1997. RESULTS: Forty patients (19 percent) had sustained atrial flutter or fibrillation before surgery. As compared with the patients who did not have atrial flutter or fibrillation before surgery, those who did were older (59+/-11 vs. 37+/-13 years, P<0.001) and had higher mean pulmonary arterial pressures (25.0+/-9.7 vs. 19.7+/-8.2 mm Hg, P=0.001). There were no perioperative deaths. After a mean follow-up period of 3.8+/-2.5 years, 24 of the 40 patients (60 percent) continued to have atrial flutter or fibrillation. The mean age of these patients was greater than that of the 16 who converted to sinus rhythm (P=0.02). New-onset atrial flutter or atrial fibrillation was more likely to have developed at follow-up in patients who were older than 40 years at the time of surgery than in those who were 40 or younger (5 of 67 vs. 0 of 106, P=0.008). Late events (those occurring more than one month after surgery) included stroke in six patients (all but one with atrial flutter or fibrillation, one of whom died) and death from noncardiac causes in two patients. Multivariate analysis showed that older age (>40 years) at the time of surgery (P=0.001), the presence of preoperative atrial flutter or fibrillation (P<0.001), and the presence of postoperative atrial flutter or fibrillation or junctional rhythm (P=0.02) were predictive of late postoperative atrial flutter or fibrillation. CONCLUSIONS: The risk of atrial flutter or atrial fibrillation in adults with atrial septal defects is related to the age at the time of surgical repair and the pulmonary arterial pressure. To reduce the morbidity associated with atrial flutter and fibrillation, the timely closure of atrial septal defects is warranted. (+info)Influence of pulmonary capillary wedge pressure on central apnea in heart failure. (6/595)
BACKGROUND: Recent studies suggest that acute pulmonary congestion induces hyperventilation and that hyperventilation-related hypocapnia leads to ventilatory control instability and central sleep apnea. Whether chronic pulmonary congestion due to congestive heart failure (CHF) is associated with central apnea is unknown. We hypothesized that CHF patients with central apnea would have greater pulmonary capillary wedge pressure (PCWP) than patients without central apnea and that PCWP would correlate with central apnea severity. METHODS AND RESULTS: Seventy-five stable CHF patients underwent right heart catheterization and, on the basis of overnight sleep studies, were divided into central apnea (n=33), obstructive apnea (n=20), or nonapnea groups (apnea-hypopnea index [AHI] <5 events per hour). Mean PCWP was significantly greater in the central than in the obstructive and nonapnea groups (mean+/-SEM [range]: 22. 8+/-1.2 [11 to 38] versus 12.3+/-1.2 [4 to 21] versus 11.5+/-1.5 [3 to 28] mm Hg, respectively; P<0.001). Within the central apnea group, PCWP correlated with the frequency and severity of central apnea (AHI: r=0.47, P=0.006) and degree of hypocapnia (PaCO2: r=-0.42, P=0. 017). Intensive medical therapy in 7 patients with initially high PCWP and central apneas reduced both PCWP (29.0+/-2.6 [20 to 38] to 22.0+/-1.8 [17 to 27] mm Hg; P<0.001) and central apnea frequency (AHI) (38.5+/-7.7 [7 to 62] to 18.5+/-5.3 [1 to 31] events per hour; P=0.005). CONCLUSIONS: PCWP is elevated in CHF patients with central apneas compared with those with obstructive apnea or without apnea. Moreover, a highly significant relationship exists between PCWP, hypocapnia, and central apnea frequency and severity. (+info)Pulmonary artery pressure variation in patients with connective tissue disease: 24 hour ambulatory pulmonary artery pressure monitoring. (7/595)
BACKGROUND: The specific contribution of secondary pulmonary hypertension to the morbidity and mortality of patients with underlying lung disease can be difficult to assess from single measurements of pulmonary artery pressure. We have studied patients with secondary pulmonary hypertension using an ambulatory system for measuring continuous pulmonary artery pressure (PAP). We chose to study patients with connective tissue disease because they represent a group at high risk of pulmonary vascular disease, but with little disturbance of lung function. METHODS: Six patients (five with progressive systemic sclerosis and one with systemic lupus erythematosis) were studied. They underwent preliminary cardiopulmonary investigations followed by Doppler echocardiography, right heart catheterisation, and ambulatory pulmonary artery pressure monitoring to measure changes in pressure over a 24 hour period including during a formal exercise test. RESULTS: All patients had pulmonary hypertension as measured by Doppler echocardiography with estimated pulmonary artery systolic pressures of 40-100 mm Hg. Pulmonary function testing revealed virtually normal spirometric values (mean FEV1 86.9% predicted) but marked reduction in CO gas transfer factor (KCO 57.8% predicted). Exercise responses were impaired with mean VO2max 50.6% predicted. Ambulatory PAP monitoring indicated significant changes in pressures with variation in posture and activity throughout 24 hours. Resting PAP did not predict the change in PAP seen on exercise. CONCLUSION: Conventional methods of assessment of the pulmonary circulation based on single measurements in the supine position may underestimate the stresses faced by the right side of the circulation. This ambulatory system allows monitoring of pulmonary haemodynamics continuously over 24 hours during normal activities of daily living. These measurements may increase our understanding of the contribution made by secondary pulmonary hypertension to the morbidity and mortality of the underlying lung disease. (+info)Relation between plasma nitrate and mean pulmonary arterial pressure in ventricular septal defect. (8/595)
BACKGROUND: Nitric oxide (NO) is known to modulate myocardial contraction and coronary tone, and its inhalation reduces pulmonary vascular resistance in patients with pulmonary hypertension. OBJECTIVES: To evaluate the pathophysiological role of NO in patients with a ventricular septal defect (VSD). PATIENTS: Twenty-nine children with VSD, nine of whom had undergone VSD closure surgery, and 14 patients with Kawasaki disease. The mean age of the VSD patients was 3.1 years (range, 2 months to 9 years). METHODS: Using high performance liquid chromatography, nitrate (a more stable NO oxidation product) was measured in plasma specimens of the patients undergoing cardiac catheterisation. RESULTS: Nitrate concentrations in the pulmonary artery bore a significant relation to mean pulmonary artery pressure, pulmonary to systemic systolic pressure ratio, and pulmonary to systemic flow ratio. CONCLUSIONS: The concentration of nitrate was in proportion to the increment in intravascular or cardiac pressure, indicating that endogenous NO is upregulated as a compensatory homeostatic attempt to reduce pulmonary pressure and blood flow. (+info)Pulmonary wedge pressure, also known as pulmonary capillary wedge pressure (PCWP) or left heart filling pressure, is a measurement obtained during right heart catheterization. It reflects the pressure in the left atrium, which is an estimate of the diastolic pressure in the left ventricle. Normal PCWP ranges from 4 to 12 mmHg. Increased pulmonary wedge pressure can indicate heart failure or other cardiac disorders that affect the left side of the heart.
Hemodynamics is the study of how blood flows through the cardiovascular system, including the heart and the vascular network. It examines various factors that affect blood flow, such as blood volume, viscosity, vessel length and diameter, and pressure differences between different parts of the circulatory system. Hemodynamics also considers the impact of various physiological and pathological conditions on these variables, and how they in turn influence the function of vital organs and systems in the body. It is a critical area of study in fields such as cardiology, anesthesiology, and critical care medicine.
Cardiac output is a measure of the amount of blood that is pumped by the heart in one minute. It is defined as the product of stroke volume (the amount of blood pumped by the left ventricle during each contraction) and heart rate (the number of contractions per minute). Normal cardiac output at rest for an average-sized adult is about 5 to 6 liters per minute. Cardiac output can be increased during exercise or other conditions that require more blood flow, such as during illness or injury. It can be measured noninvasively using techniques such as echocardiography or invasively through a catheter placed in the heart.
Heart failure is a pathophysiological state in which the heart is unable to pump sufficient blood to meet the metabolic demands of the body or do so only at the expense of elevated filling pressures. It can be caused by various cardiac disorders, including coronary artery disease, hypertension, valvular heart disease, cardiomyopathy, and arrhythmias. Symptoms may include shortness of breath, fatigue, and fluid retention. Heart failure is often classified based on the ejection fraction (EF), which is the percentage of blood that is pumped out of the left ventricle during each contraction. A reduced EF (less than 40%) is indicative of heart failure with reduced ejection fraction (HFrEF), while a preserved EF (greater than or equal to 50%) is indicative of heart failure with preserved ejection fraction (HFpEF). There is also a category of heart failure with mid-range ejection fraction (HFmrEF) for those with an EF between 40-49%.
Vascular resistance is a measure of the opposition to blood flow within a vessel or a group of vessels, typically expressed in units of mmHg/(mL/min) or sometimes as dynes*sec/cm^5. It is determined by the diameter and length of the vessels, as well as the viscosity of the blood flowing through them. In general, a decrease in vessel diameter, an increase in vessel length, or an increase in blood viscosity will result in an increase in vascular resistance, while an increase in vessel diameter, a decrease in vessel length, or a decrease in blood viscosity will result in a decrease in vascular resistance. Vascular resistance is an important concept in the study of circulation and cardiovascular physiology because it plays a key role in determining blood pressure and blood flow within the body.
Blood pressure is the force exerted by circulating blood on the walls of the blood vessels. It is measured in millimeters of mercury (mmHg) and is given as two figures:
1. Systolic pressure: This is the pressure when the heart pushes blood out into the arteries.
2. Diastolic pressure: This is the pressure when the heart rests between beats, allowing it to fill with blood.
Normal blood pressure for adults is typically around 120/80 mmHg, although this can vary slightly depending on age, sex, and other factors. High blood pressure (hypertension) is generally considered to be a reading of 130/80 mmHg or higher, while low blood pressure (hypotension) is usually defined as a reading below 90/60 mmHg. It's important to note that blood pressure can fluctuate throughout the day and may be affected by factors such as stress, physical activity, and medication use.
Cardiac catheterization is a medical procedure used to diagnose and treat cardiovascular conditions. In this procedure, a thin, flexible tube called a catheter is inserted into a blood vessel in the arm or leg and threaded up to the heart. The catheter can be used to perform various diagnostic tests, such as measuring the pressure inside the heart chambers and assessing the function of the heart valves.
Cardiac catheterization can also be used to treat certain cardiovascular conditions, such as narrowed or blocked arteries. In these cases, a balloon or stent may be inserted through the catheter to open up the blood vessel and improve blood flow. This procedure is known as angioplasty or percutaneous coronary intervention (PCI).
Cardiac catheterization is typically performed in a hospital cardiac catheterization laboratory by a team of healthcare professionals, including cardiologists, radiologists, and nurses. The procedure may be done under local anesthesia with sedation or general anesthesia, depending on the individual patient's needs and preferences.
Overall, cardiac catheterization is a valuable tool in the diagnosis and treatment of various heart conditions, and it can help improve symptoms, reduce complications, and prolong life for many patients.
In medical terms, pressure is defined as the force applied per unit area on an object or body surface. It is often measured in millimeters of mercury (mmHg) in clinical settings. For example, blood pressure is the force exerted by circulating blood on the walls of the arteries and is recorded as two numbers: systolic pressure (when the heart beats and pushes blood out) and diastolic pressure (when the heart rests between beats).
Pressure can also refer to the pressure exerted on a wound or incision to help control bleeding, or the pressure inside the skull or spinal canal. High or low pressure in different body systems can indicate various medical conditions and require appropriate treatment.
Central venous pressure (CVP) is the blood pressure measured in the large veins that enter the right atrium of the heart. It reflects the amount of blood returning to the heart and the ability of the heart to pump it effectively. CVP is used as an indicator of a person's intravascular volume status, cardiac function, and overall hemodynamic performance. The measurement is taken using a central venous catheter placed in a large vein such as the internal jugular or subclavian vein. Normal CVP values range from 0 to 8 mmHg (millimeters of mercury) in adults when measured at the level of the right atrium.
Hydrostatic pressure is the pressure exerted by a fluid at equilibrium at a given point within the fluid, due to the force of gravity. In medical terms, hydrostatic pressure is often discussed in relation to body fluids and tissues. For example, the hydrostatic pressure in the capillaries (tiny blood vessels) is the force that drives the fluid out of the blood vessels and into the surrounding tissues. This helps to maintain the balance of fluids in the body. Additionally, abnormal increases in hydrostatic pressure can contribute to the development of edema (swelling) in the tissues.
Ventricular pressure refers to the pressure within the ventricles, which are the lower chambers of the heart. In the left ventricle, the pressure measures the force that the blood exerts on the walls as it is pumped out to the rest of the body. In the right ventricle, the pressure measures the force of the blood being pumped into the pulmonary artery and ultimately to the lungs for oxygenation.
Normally, the left ventricular pressure ranges from 8-12 mmHg at rest when the heart is relaxed (diastolic pressure) and can increase up to 120-140 mmHg during contraction (systolic pressure). The right ventricular pressure is lower than the left, with a normal diastolic pressure of 0-6 mmHg and a systolic pressure ranging from 15-30 mmHg.
Abnormal ventricular pressures can indicate various heart conditions, such as heart failure, hypertension, or valvular heart disease. Regular monitoring of ventricular pressure is essential in managing these conditions and ensuring proper heart function.
Pulmonary edema is a medical condition characterized by the accumulation of fluid in the alveoli (air sacs) and interstitial spaces (the area surrounding the alveoli) within the lungs. This buildup of fluid can lead to impaired gas exchange, resulting in shortness of breath, coughing, and difficulty breathing, especially when lying down. Pulmonary edema is often a complication of heart failure, but it can also be caused by other conditions such as pneumonia, trauma, or exposure to certain toxins.
In the early stages of pulmonary edema, patients may experience mild symptoms such as shortness of breath during physical activity. However, as the condition progresses, symptoms can become more severe and include:
* Severe shortness of breath, even at rest
* Wheezing or coughing up pink, frothy sputum
* Rapid breathing and heart rate
* Anxiety or restlessness
* Bluish discoloration of the skin (cyanosis) due to lack of oxygen
Pulmonary edema can be diagnosed through a combination of physical examination, medical history, chest X-ray, and other diagnostic tests such as echocardiography or CT scan. Treatment typically involves addressing the underlying cause of the condition, as well as providing supportive care such as supplemental oxygen, diuretics to help remove excess fluid from the body, and medications to help reduce anxiety and improve breathing. In severe cases, mechanical ventilation may be necessary to support respiratory function.
Swan-Ganz catheterization is a medical procedure in which a Swan-Ganz catheter, also known as a pulmonary artery catheter, is inserted into a patient's vein and guided through the heart to the pulmonary artery. The procedure is named after its inventors, Dr. Jeremy Swan and Dr. William Ganz.
The Swan-Ganz catheter is a thin, flexible tube that is equipped with sensors that measure various cardiac functions, such as blood pressure in the heart chambers and lungs, oxygen saturation of the blood, and cardiac output. This information helps doctors evaluate heart function, diagnose heart conditions, and monitor treatment effectiveness.
Swan-Ganz catheterization is typically performed in a hospital setting by trained medical professionals, such as cardiologists or critical care specialists. The procedure may be used to diagnose and manage various heart conditions, including heart failure, pulmonary hypertension, and shock. It may also be used during major surgeries or other medical procedures to monitor the patient's hemodynamic status.
Like any medical procedure, Swan-Ganz catheterization carries some risks, such as infection, bleeding, and damage to blood vessels or heart structures. However, these complications are relatively rare when the procedure is performed by experienced medical professionals.
Pulmonary circulation refers to the process of blood flow through the lungs, where blood picks up oxygen and releases carbon dioxide. This is a vital part of the overall circulatory system, which delivers nutrients and oxygen to the body's cells while removing waste products like carbon dioxide.
In pulmonary circulation, deoxygenated blood from the systemic circulation returns to the right atrium of the heart via the superior and inferior vena cava. The blood then moves into the right ventricle through the tricuspid valve and gets pumped into the pulmonary artery when the right ventricle contracts.
The pulmonary artery divides into smaller vessels called arterioles, which further branch into a vast network of tiny capillaries in the lungs. Here, oxygen from the alveoli diffuses into the blood, binding to hemoglobin in red blood cells, while carbon dioxide leaves the blood and is exhaled through the nose or mouth.
The now oxygenated blood collects in venules, which merge to form pulmonary veins. These veins transport the oxygen-rich blood back to the left atrium of the heart, where it enters the systemic circulation once again. This continuous cycle enables the body's cells to receive the necessary oxygen and nutrients for proper functioning while disposing of waste products.
Heart rate is the number of heartbeats per unit of time, often expressed as beats per minute (bpm). It can vary significantly depending on factors such as age, physical fitness, emotions, and overall health status. A resting heart rate between 60-100 bpm is generally considered normal for adults, but athletes and individuals with high levels of physical fitness may have a resting heart rate below 60 bpm due to their enhanced cardiovascular efficiency. Monitoring heart rate can provide valuable insights into an individual's health status, exercise intensity, and response to various treatments or interventions.
Stroke volume is a term used in cardiovascular physiology and medicine. It refers to the amount of blood that is pumped out of the left ventricle of the heart during each contraction (systole). Specifically, it is the difference between the volume of blood in the left ventricle at the end of diastole (when the ventricle is filled with blood) and the volume at the end of systole (when the ventricle has contracted and ejected its contents into the aorta).
Stroke volume is an important measure of heart function, as it reflects the ability of the heart to pump blood effectively to the rest of the body. A low stroke volume may indicate that the heart is not pumping efficiently, while a high stroke volume may suggest that the heart is working too hard. Stroke volume can be affected by various factors, including heart disease, high blood pressure, and physical fitness level.
The formula for calculating stroke volume is:
Stroke Volume = End-Diastolic Volume - End-Systolic Volume
Where end-diastolic volume (EDV) is the volume of blood in the left ventricle at the end of diastole, and end-systolic volume (ESV) is the volume of blood in the left ventricle at the end of systole.
Pulmonary wedge pressure
Preload (cardiology)
Pulmonary artery catheter
Earl Wood
Myxoma
Cardiac catheterization
Impella
PYGB
Lung allocation score
Candoxatril
Sulmazole
Amrinone
Swimming-induced pulmonary edema
Pericarditis
Circulatory system
Mitral stenosis
Jugular venous pressure
Hypertrophic cardiomyopathy
List of MeSH codes (G09)
PWP
Hyperdynamic circulation
Central venous pressure
Portopulmonary hypertension
Acute respiratory distress syndrome
Positive end-expiratory pressure
Afterload
Pulmonary edema
Right atrial pressure
Atrial septal defect
Vascular resistance
Pulmonary wedge pressure - Wikipedia
Pulmonary Wedge Pressure | Profiles RNS
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Capillary wedge15
- The pulmonary wedge pressure (PWP) (also called pulmonary arterial wedge pressure (PAWP), pulmonary capillary wedge pressure (PCWP), pulmonary artery occlusion pressure (PAOP), or cross-sectional pressure) is the pressure measured by wedging a pulmonary artery catheter with an inflated balloon into a small pulmonary arterial branch. (wikipedia.org)
- citation needed] Physiologically, distinctions can be drawn among pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary venous pressure and left atrial pressure, but not all of these can be measured in a clinical context. (wikipedia.org)
- It has also been used to diagnose severity of left ventricular failure and mitral stenosis, given that elevated pulmonary capillary wedge pressure strongly suggests failure of left ventricular output. (wikipedia.org)
- Brinkley DM, Ho KKL, Drazner MH, Kociol RD. The prognostic value of the relationship between right atrial and pulmonary capillary wedge pressure in diverse cardiovascular conditions. (umassmed.edu)
- Pulmonary edemas that are above certain levels are a life-threatening condition, and through periodic capillary wedge pressure measurements, a doctor can efficaciously tailor use of diuretics. (thehealthboard.com)
- In this population, the use of NATRECOR reduced pulmonary capillary wedge pressure and improved symptomatic dyspnea when measured at 3 hours of infusion. (nih.gov)
- In this population, the use of NATRECOR reduced pulmonary capillary wedge pressure and improved short term (3 hours) symptoms of dyspnea. (nih.gov)
- Background :The aim of this study was to validate whether pulmonary capillary wedge pressure estimated using transoesophageal echocardiography in anaesthetised patients receiving mechanical ventilation can be comparable to gold standard method of estimating PCWP by using pulmonary artery catheter. (amrita.edu)
- In patients with pre-existing left ventricular dysfunction, GENOSYL may increase pulmonary capillary wedge pressure leading to pulmonary edema. (gabio.org)
- Hemodynamic parameters included pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP). (ku.dk)
- The approval was based on the results of studies showing that nesiritide reduced pulmonary capillary wedge pressure and improved dyspnea in this population. (yourlawyer.com)
- Heart rate, arterial pressure, central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, body temperature, cardiac output, and PCV were measured immediately prior to and at selected times after romifidine administration. (avma.org)
- Results -Romifidine induced a decrease in heart rate, pulmonary arterial pressure, rate-pressure product, cardiac index, and right ventricular stroke work index and an increase in central venous pressure, pulmonary capillary wedge pressure, and systemic vascular resistance index. (avma.org)
- The pulmonary artery wedge pressure or PWP is also referred to as the pulmonary capillary wedge pressure or PCWP. (medicineport.com)
- Dilatation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). (prescriptiondrugs.com)
Hypertension43
- It may also be used for diagnoses of severe burns, multi-organ system failures, and idiopathic pulmonary hypertension . (thehealthboard.com)
- The Registry to EValuate Early And Long-term pulmonary arterial hypertension disease management (REVEAL Registry) was established to provide updated characteristics of patients with pulmonary arterial hypertension (PAH) and to improve diagnosis, treatment, and management. (nih.gov)
- Pulmonary hypertension (PH) affects about 1% of the global population and 10% of persons older than 65 years. (medscape.com)
- To measure the prevalence of different types of pulmonary hypertension (PH) and to identify patients with systemic sclerosis (SSc) at highest risk in a multicenter European sample, with a metaanalysis of relevant studies. (jrheum.org)
- Precapillary PH was found in 64 patients (5%), of whom 42 had pulmonary arterial hypertension (PAH) and 22 had PH secondary to interstitial lung disease (ILD). (jrheum.org)
- Pulmonary hypertension (PH) is a fatal disorder characterized by an increase in pulmonary vascular resistance, which leads to right ventricular failure. (jrheum.org)
- The Dana Point classification distinguishes pulmonary arterial hypertension (PAH) from PH secondary to other morbid entities 1 . (jrheum.org)
- March 24, 2020, - VERO Biotech LLC, an Atlanta, Georgia-based biotechnology company focused on saving lives, alleviating suffering, and improving the health economics of care, today announced that the first patient with COVID-19 infection complicating pulmonary hypertension has been treated with its proprietary inhaled nitric oxide (iNO) delivery system, GENOSYL Ã’ DS at home. (gabio.org)
- Treating patients at home with a tankless system to deliver iNO represents a new paradigm in the management of pulmonary hypertension," said Michael Gentile, RRT and Vice President of Medical Affairs, Vero Biotech. (gabio.org)
- 34 weeks gestation) neonates with hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension in conjunction with ventilatory support and other appropriate agents. (gabio.org)
- In the airways, nitric oxide targets the vascular smooth muscle cells that surround the small resistance arteries in the lungs and is used in adult respiratory distress syndrome and persistent pulmonary hypertension of the neonate. (gabio.org)
- Pre-Capillary, Combined, and Post-Capillary Pulmonary Hypertension: A Pathophysiological Continuum. (acc.org)
- While therapy for patients with pulmonary arterial hypertension (PAH) has evolved into an integrated, and mostly evidence-based, treatment approach combining supportive, pharmacologic and surgical therapies, the optimal treatment of patients with left heart disease with preserved left ventricular systolic function and severe pulmonary hypertension (PH-HFpEF) remains unclear. (acc.org)
- Hemodynamic key parameters such as mean pulmonary artery pressure (46 ± 9 mm Hg) and cardiac index (2.2 ± 0.7 l/min/m 2 ) were as severely compromised as in patients with idiopathic pulmonary arterial hypertension (IPAH), and the elevated transpulmonary gradient (26 ± 9 mm Hg) documents a relevant pre-capillary component in the presence of severe combined post- and pre-capillary PH (Cpc-PH). (acc.org)
- Inspired by the AMBITION (Ambrisentan and Tadalafil in Patients with Pulmonary Arterial Hypertension) investigators 4 we explored the question whether in COMPERA all patients fulfilling the formal diagnostic criteria of IPAH are alike (e.g. typical IPAH), or is there a group of patients with "atypical" IPAH? (acc.org)
- Pulmonary hypertension associated with left-sided heart disease (PH-LHD) is the most common type of pulmonary hypertension. (smw.ch)
- In patients with left-sided heart disease, the presence of pulmonary hypertension is typically a marker of more advanced disease, more severe symptoms, and worse prognosis. (smw.ch)
- In contrast to pulmonary arterial hypertension, PH-LHD is characterised by an elevated pulmonary artery wedge pressure (postcapillary pulmonary hypertension) without or with an additional precapillary component (isolated postcapillary vs combined postcapillary and precapillary pulmonary hypertension). (smw.ch)
- Transthoracic echocardiography is the primary noninvasive imaging tool to estimate the probability of pulmonary hypertension and to establish a working diagnosis on the mechanism of pulmonary hypertension. (smw.ch)
- However, right heart catheterisation is always required if significant pulmonary hypertension is suspected and exact knowledge of the haemodynamic constellation is necessary. (smw.ch)
- There is currently no established indication for pulmonary arterial hypertension-specific therapies in PH-LHD, and specific therapies may even cause harm in patients with PH-LHD. (smw.ch)
- 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). (smw.ch)
- Pulmonary hypertension associated with left heart and lung diseases. (smw.ch)
- Left ventricular heart failure and pulmonary hypertension. (smw.ch)
- Pulmonary hypertension due to left heart diseases. (smw.ch)
- Maeder MT, Kleiner R, Weilenmann D. Severely worsening dyspnea after initiation of macitentan therapy for pulmonary arterial hypertension. (smw.ch)
- Pulmonary hypertension in the elderly: a word of caution. (smw.ch)
- Pulmonary Hypertension in Heart Failure. (smw.ch)
- Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. (smw.ch)
- Pulmonary hypertension predicts mortality and morbidity in patients with dilated cardiomyopathy. (smw.ch)
- Pulmonary arterial hypertension (PAH) is a rare complication of primary Sjögren's syndrome (pSS). (biomedcentral.com)
- Vasotec (enalapril maleate) is an ACE ( angiotensin converting enzyme ) inhibitor used to treat high blood pressure ( hypertension ), congestive heart failure , kidney problems caused by diabetes , and to improve survival after a heart attack . (rxlist.com)
- Abstract Background: Pulmonary hypertension (PH) is a significant preoperative risk factor. (researchsquare.com)
- Methods: We conducted a retrospective cohort study of adults with pulmonary hypertension having surgery at a single large medical referral center. (researchsquare.com)
- Patients with pulmonary hypertension (PH) are at increased risk for perioperative morbidity and mortality [1-3], and PH is an independent risk factor for complications after noncardiac surgery [4]. (researchsquare.com)
- Patients with PH, 18 years and older, were identified from the Mayo Clinic Pulmonary Hypertension database with rationale that patients in registry have complete and detailed assessments of their PH. (researchsquare.com)
- Because of fundamental differences in pathophysiologic changes, including in right ventricular afterload in postcapillary PH, patients with established group 2 PH (pulmonary venous hypertension) were not included [12]. (researchsquare.com)
- AIMS: Remodelling of the extracellular matrix (ECM) is a key mechanism involved in the development and progression of heart failure (HF) but also functional in associated pulmonary hypertension (PH). (lu.se)
- Despite advances in drug therapy, pulmonary hypertension-particularly arterial hypertension (PAH)-remains a fatal disease. (revespcardiol.org)
- Percutaneous balloon pulmonary angioplasty, another interventional therapy, has re-emerged in the last few years as a clear alternative for the management of patients with distal, inoperable, chronic thromboembolic pulmonary hypertension. (revespcardiol.org)
- The current review discusses the physiological background, experimental evidence, and potential clinical and hemodynamic benefits of all these interventional therapies regarding their use in the setting of RHF due to severe pulmonary hypertension. (revespcardiol.org)
- Conversely, a high mean PAP in obstructed subjects in the absence of arterial oxygen desaturation suggests that pulmonary hypertension is related to anatomic restriction of the pulmonary vascular bed rather than to alveolar hypoventilation or to a mismatching of blood flow and ventilation. (cdc.gov)
- In 1994, a consensus definition was recommended for ARDS: acute onset of respiratory failure, bilateral infiltrates on chest radiograph, pulmonary artery wedge pressure less than or equal to 18 mm Hg, or the absence of clinical evidence of left atrial hypertension, PaO 2 /FIO 2 less than or equal to 300 (acute lung injury) or PaO 2 /FIO 2 less than or equal to 200 (ARDS). (medicosecuador.com)
Catheter10
- McGee WT, Mailloux P, Jodka P, Thomas J. The pulmonary artery catheter in critical care. (umassmed.edu)
- The pulmonary wedge pressure is measured with the help of the pulmonary artery catheter. (medicineport.com)
- Pulmonary wedge pressure (PWP) is both a diagnostic and therapeutic medical tool for taking measurements, using a wedged balloon in a pulmonary catheter and inflated within a pulmonary artery . (thehealthboard.com)
- Pressures are measured by inserting the balloon-tipped catheter into peripheral veins and through these veins entering into the right atrium of the heart and from there into pulmonary arteries. (thehealthboard.com)
- The risks and possible complications from using a pulmonary catheter show that the most common and a serious complication is a pulmonary artery rupture. (thehealthboard.com)
- A common complication upon insertion of the pulmonary catheter is heart arrhythmias. (thehealthboard.com)
- Methods : A cross sectional validity study conducted in a tertiary care cardiac centre in south India over a period of 6 months from February 2016 - August 2016 among 100 patients undergoing cardiac surgery where intraoperative TEE and pulmonary artery catheter used. (amrita.edu)
- Swan-Ganz catheterization (also called right heart catheterization or pulmonary artery catheterization) is the passing of a thin tube (catheter) into the right side of the heart and the arteries leading to the lungs. (medlineplus.gov)
- You may also feel some pressure at the site when the catheter is inserted. (medlineplus.gov)
- During angiography, a catheter is placed selectively via either the transjugular or transfemoral route into the hepatic vein to measure portal pressure. (medscape.com)
Atrial pressure3
- It estimates the left atrial pressure. (wikipedia.org)
- Because of the large compliance of pulmonary circulation, it provides an indirect measure of the left atrial pressure. (wikipedia.org)
- Measurements of systolic and diastolic pressures there give right atrial pressure readings and as the balloon deflates once more, left atrial pressures are estimated. (thehealthboard.com)
Catheterization3
- Some of the diagnostic uses of pulmonary wedge pressure catheterization are for shock states, valvular disease, pulmonary embolisms , and cardiac tamponade, which is a collection of blood in the pericardium causing compression. (thehealthboard.com)
- The mean duration between symptom onset and diagnostic catheterization was 2.8 years, and 1,008 (41.3%) patients were treated with more than one pulmonary vascular-targeted medication. (nih.gov)
- Consecutive patients with SSc recruited at 11 French and Italian centers underwent detailed evaluations, including Doppler echocardiography, chest computed tomography, pulmonary function tests, and right-heart catheterization (RHC), to detect the presence and causes of PH. (jrheum.org)
Edema4
- Traditionally, it was believed that pulmonary edema with normal PWP suggested a diagnosis of acute respiratory distress syndrome (ARDS) or non cardiogenic pulmonary edema (as in opiate poisoning). (wikipedia.org)
- However, since capillary hydrostatic pressure exceeds wedge pressure once the balloon is deflated (to promote a gradient for forward flow), a normal wedge pressure cannot conclusively differentiate between hydrostatic pulmonary edema and ARDS. (wikipedia.org)
- The acute respiratory distress syndrome (ARDS) is a disorder of diffuse lung injury secondary to a wide variety of clinical insults (eg, sepsis) and is manifested by impaired oxygenation, pulmonary edema, and decreased static and dynamic compliance. (nih.gov)
- Causes of ARDS due to direct lung injury include pneumonia, aspiration of gastric contents, pulmonary contusion, fat emboli, near-drowning, inhalational injury, and reperfusion pulmonary edema after lung transplantation or pulmonary embolectomy. (medicosecuador.com)
PAWP1
- Values of systemic vascular resistance index (SVRI), heart rate (HR), pulmonary artery wedge pressure (PAWP) and cardiac index (CI) at hours 3, 6, 9 and 12 of the experiment were compared. (nel.edu)
Arterial wedge1
- Usefulness of the pulmonary arterial systolic pressure to predict pulmonary arterial wedge pressure in patients with normal left ventricular systolic function. (umassmed.edu)
Systolic function1
- Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. (smw.ch)
Idiopathic pulmonary2
- Idiopathic pulmonary fibrosis (or cryptogenic fibrosing alveolitis) (IPF or CFA) is one of several idiopathic interstitial pneumonias. (atsjournals.org)
- The purpose of this consensus statement is to provide assistance to clinicians in the diagnosis and management of idiopathic pulmonary fibrosis (IPF). (atsjournals.org)
Systemic vascular r2
- The left ventricle (LV) must generate a relatively high-pressure gradient to overcome the high systemic vascular resistance (SVR), whereas the RV needs to generate a lower pressure gradient to overcome the lower pulmonary vascular resistance (PVR). (medscape.com)
- Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). (prescriptiondrugs.com)
Shunt1
- Metaproterenol tended to increase PaO2/PAO2, but had no effect on pulmonary shunt or dead space ventilation. (nih.gov)
Circulation4
- Pulmonary Circulation: Diseases and their treatment. (wikipedia.org)
- The systemic or pulmonary circulation may depend on the patency of the ductus arteriosus, especially in patients presenting in the first few days of life. (medscape.com)
- Obstructive proliferative vasculopathy of the small and medium-size pulmonary arterial circulation and chronic hypoxemia due to advanced lung disease are major causes of precapillary PH in SSc 7 , 8 . (jrheum.org)
- Inflammatory mediators (cytokines, chemokines) may translocate into the pulmonary circulation secondary to increased alveolar-capillary permeability, resulting in systemic inflammation. (medicosecuador.com)
Acute3
- Vascular pedicle width in acute lung injury: correlation with intravascular pressures and ability to discriminate fluid status. (umassmed.edu)
- Pulmonary wedge pressure measures lung water changes, which can signal pulmonary venoconstrictions in patients with acute respiratory distress syndrome (ARDS) and hypoxemia. (thehealthboard.com)
- Many acute and chronic lung disorders with variable degrees of pulmonary inflammation and fibrosis are collectively referred to as interstitial lung diseases (ILDs) or diffuse parenchymal lung diseases. (atsjournals.org)
Venous pressures2
- The tool can measure distinctive differences between artery and venous pressures, which can possibly be due to arterial venous malformations (AVMs). (thehealthboard.com)
- Congestive heart failure occurs when the heart can no longer meet the metabolic demands of the body at normal physiologic venous pressures. (medscape.com)
Hemodynamics3
- Causes of primary diastolic dysfunction include an anatomic obstruction that prevents ventricular filling (eg, pulmonary venous obstruction), a primary reduction in ventricular compliance (eg, cardiomyopathy, transplant rejection), external constraints (eg, pericardial effusion), and poor hemodynamics after the Fontan procedure (eg, elevated pulmonary vascular resistance). (medscape.com)
- Pulmonary hemodynamics in symptomatic coal miners. (cdc.gov)
- Pulmonary hemodynamics were studied in 47 coal miners with pneumoconiosis. (cdc.gov)
Gradient2
- In steady state, the cardiac output through the two systems is equal, and Ohm's law suggests that the pressure gradient required to pump through each system is inversely dependent on its resistance. (medscape.com)
- Pulmonary arterial pressure (PAP), pulmonary wedge pressure, arterial oxygen tension, alveolar arterial oxygen gradient (AaPO2), and pulmonary functions were determined for each subject at rest and after 5 minutes of exercise. (cdc.gov)
ARDS2
- The clinical disorders commonly associated with ARDS can be divided into those associated with direct injury to the lung (pulmonary ARDS) and those that cause indirect lung injury in the setting of a systemic process (extrapulmonary ARDS). (medicosecuador.com)
- When traditional tidal volumes of 10 to 15 mL/kg are used in patients with ALI/ARDS receiving mechanical ventilation, the resulting alveolar pressures are frequently elevated, reflecting over-distention particularly of the less-affected lung regions. (medicosecuador.com)
Vascular bed1
- In a pathologic state, PH of all forms leads to an increase in resistance to flow across the pulmonary vascular bed. (medscape.com)
MmHg1
- 30 mmHg was abandoned because healthy individuals can exceed this threshold at high cardiac output (CO). We hypothesised that incorporating assessment of the pressure-flow relationship using the mPAP/CO ratio, i.e. total pulmonary resistance (TPR), might enhance the accuracy of diagnosing an abnormal exercise haemodynamic response. (ersjournals.com)
Oxygenation1
- Abrupt discontinuation of GENOSYL (nitric oxide) gas, for inhalation may lead to worsening oxygenation and increasing pulmonary artery pressure. (gabio.org)
Left ventricular output1
- Angiotensin-converting enzyme inhibitors to effect afterload reduction are generally prescribed to augment left ventricular output with consequent improvement of forward pulmonary flow. (medscape.com)
Heart failure3
- Pulmonary wedge pressure can be measured to determine if habitual shallow breathing necessitates the use of supplemental oxygen in patients with heart failure. (thehealthboard.com)
- Overall, the PH-HFpEF cohort described in our paper is the result of a restrictive selection process at PH expert centers, and probably does not reflect the usual heart failure patient with some degree of pulmonary artery pressure elevation. (acc.org)
- Echo evidence of diastolic dysfunction/elevated filling pressures manifest by medial E/e' ratio ≥ 15 and/or left atrial enlargement and chronic treatment with a diuretic for signs or symptoms of heart failure. (mayo.edu)
Severe1
- In assessing shock states, pulmonary wedge pressure readings can be taken to determine if tachycardia or hypotension are present, if there are inadequate ventricular fillings, or if a severe depression in cardiac performance has put a patient into a state of cardiogenic shock. (thehealthboard.com)
Chronic1
- [ 7 ] In most individuals with chronic PH, the progression is gradual, allowing the right heart time for remodeling and hypertrophy in response to the increased pressure. (medscape.com)
Hypoxemia1
- Avoiding high inspiratory pressures also avoids opening collapsed alveoli which may prevent atelectrauma but promote hypoxemia. (medicosecuador.com)
Diastolic dysfunction1
- Diastolic dysfunction results from decreased ventricular compliance, necessitating an increase in venous pressure to maintain adequate ventricular filling. (medscape.com)
Diseases2
- Pulmonary venoocclusive disease is also a recognized cause of PH, which is thought to be more common in connective tissue diseases 9 . (jrheum.org)
- Panel members are experts in adult pulmonary diseases. (atsjournals.org)
Blood11
- In cases of septic shock , which is the most common form of intensive care unit ( ICU ) deaths in the United States, a PWP reading can detect the low filling pressures that inform of profound peripheral vasodilations that rob organs of blood. (thehealthboard.com)
- Monitor blood pressure closely during NATRECOR administration. (nih.gov)
- If hypotension occurs during the administration of NATRECOR, reduce the dose of or discontinue NATRECOR and initiate other measures to support blood pressure (IV fluids, changes in body position). (nih.gov)
- preCARDIA is designed to reduce filling pressure as blood enters the heart and lungs, which may enable the heart and kidneys to work more effectively, potentially providing therapy for patients non-responsive to diuretics, estimated to be approximately 300,000 of the one million U.S. ADHF admissions per year. (financialcontent.com)
- It is done to monitor the heart's function and blood flow and pressures in and around the heart. (medlineplus.gov)
- Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension. (proprofs.com)
- The blood pressure lowering effects of VASOTEC and thiazides are approximately additive. (rxlist.com)
- The quantitative relationship between plasma verapamil concentrations and blood pressure reduction has not been fully characterized. (drugs.com)
- Securing a stable blood pressure heat exhaustion thirst fatigue nausea oliguria giddiness weakness dizziness confusion nausea weakness vomiting respirations quickly cease and unconsciousness develops elevated cohb levels lead poisoning saturnine gout bursitis or tendinitis due to the internal environment. (elastizell.com)
- The main function of the pulmonary artery is to carry blood from the heart to the lungs. (medicineport.com)
- they include review of recent blood pressure readings, surgical procedures, and drug and x-ray contrast administration. (msdmanuals.com)
Baseline1
- This compensation allows increased contractility and brings stroke volume closer to baseline despite the increases in pressure and afterload. (medscape.com)