Jugular venous Pressure and pulmonary wedge pressure

[Reza]

Hey, i couldn't upload mine for some reason, kept saying it failed, so
pasted it here.

1) What is JVP? What is it? How is it done? When is it used? Same for
PWP.

* Jugular venous pressure and pulse is used to analyse heamodynamic
properties of the right side of the heart, and is reflected by various
wave changes in atrial relaxation and contraction. It can also be used
to estimate CVP.
* The normal jugular venous pulse wave or right atrial pressure wave
recordings usually consist of three positive waves, a, c and v, and
two negative waves, x and y. These waves can be analysed to determine
the efficiency of atrial contraction and relaxation as well as the
efficiency of valves.
How to examine the JVP1,2,3
* Use the right internal jugular vein (IJV)
* Patient should be at a 45° angle
* Head turned slightly to the left
* If possible have a tangential light source that shines obliquely
from the left
* Locate the surface markings of the IJV - runs from medial end of
clavicle to the ear lobe under medial aspect of the
sternocleidomastoid
* Locate the JVP - look for the double waveform pulsation (palpating
the contralateral carotid pulse will help)
* Measure the level of the JVP by measuring the vertical distance
between the sternal angle and the top of the JVP. Measure the height -
usually less than 3cm
*
In patients suspected of right ventricular failure but having normal
resting venous pressure, the abdominojugular( also known as the
hepatojugular) test is useful. With the patient breathing normally,
firm pressure is applied with the palm of the hand to the right upper
quadrant of the abdomen for 10 or more s.The patient should be
instructed to continue breathing normally during the test. In most
subjects the venous pressure is not altered significantly. In some
normal patients there is a transient increase in jugular venous
pressure with the "rapid return" to or near baseline in less than 10
s. The dysfunctioning right ventricle, however, is unable to accept
the increment of blood volume due to enhanced venous without of marked
increase in its filling pressure, which is transmitted to the neck
veins. In patients with right ventricular failure, which often results
from left- sided heart failure, the venous pressure either rises
rapidly and declined slowly during abdominal compression or remains
elevated by 4 or more centimeters of blood until pressures released
(figure 203-a). Ducas et al. studied the abdominal jugular test and
attested to the accuracy of the test results.
The most common cause of elevated jugular venous as pressure is an
increase right ventricular pressure such as occurs in patients with
pulmonary stenosis , pulmonary hypertension, or right ventricular
failure secondary to right ventricular infarction. The venous pressure
also is elevated when obstruction to right ventricular inflow
occurs,such as with tricuspid stenosis or right atrial myxoma, or when
constructive pericardial disease impedes right ventricular inflow.
Pulmonary Wedge Pressure

* Pulmonary capillary wedge pressure (PCWP) provides an indirect
estimate of left atrial pressure (LAP). Although left ventricular
pressure can be directly measured by placing a catheter into the left
ventricle by feeding it through a peripheral artery, into the aorta,
and then into the ventricle, it is not feasible to advance this
catheter back into the left atrium. LAP can be measured by placing a
special catheter into the right atrium then punching through the
interatrial septum; however, for obvious reasons, this is not usually
performed because of damage to the septum and potential harm to the
patient
* PCWP is measured by inserting balloon-tipped, multi-lumen catheter
(Swan-Ganz catheter) into a peripheral vein, then advancing the
catheter into the right atrium, right ventricle, pulmonary artery, and
then into a branch of the pulmonary artery. Just behind the tip of the
catheter is a small balloon that can be inflated with air
* It is important to measure PCWP to diagnose the severity of left
ventricular failure and to quantify the degree of mitral valve
stenosis. Both of these conditions elevate LAP and therefore PCWP.
* PCWP is also useful in evaluating blood volume status when fluids
are administered during hypotensive shock. One practice is to
administer fluids at a rate that maintains PCWP between 12-14 mmHg


Pulmonary Artery & Pulmonary Wedge Pressure Patterns

Increased PAP, Normal PWP
Pulmonary embolus
Emphysema
COPD
Asthma
Primary Pulmonary Hypertension (PPH)

Increased PAP, Increased PWP
CHF
Hypervolemia
Pulmonary Edema (LVF)
High PEEP Effect

Decreased PAP, Decreased PWP
Hypovelema
Right Heart Failure
Shock, Vasodialtion


http://www.ac.cc.md.us/careers/health/resptherapy/powerpoint/hemodynamics3_files/frame.htm
http://www.cvphysiology.com/Heart%20Failure/HF008.htm
http://www.patient.co.uk/showdoc/40000502/

http://www.rjmatthewsmd.com/Definitions/venous_pulse.htm