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?

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College Answer

The abnormalities are Pulsus Alternans, pulmonary hypertension, systolic hypotension, tricuspid incompetence (large v waves).


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.