Question 3.3
This is the monitor strip of a 40 year old man 5 hours post Aortic Valve Replacement for severe Aortic Incompetence. Six waveforms are shown.
From top to bottom:
a) The top two traces are the ECG waveforms.
b) The third trace is an arterial waveform, (scale: 50-150 mm Hg)
c) the fourth trace is a pulmonary artery waveform (scale: 0 - 60 mm Hg), d) the fifth trace is a CVP waveform (scale: 5-30 mm Hg) and
e) the sixth trace is a pulse oximetry waveform
What haemodynamic abnormalities are illustrated in the above data set?
College Answer
The abnormalities are Pulsus Alternans, pulmonary hypertension, systolic hypotension, tricuspid incompetence (large v waves).
Discussion
There seems to be little to discuss. Pulsus alternans is difficult to miss. Similarly, the presence of massive fused cv waves in the CVP trace is a end-of-the-bed diagnosis of tricuspid regurgitation.
Abnormal CVP waveforms are discussed elsewhere.