Heart Chamber Pressures

Diagnosis of heart diseases has been revolutionised after the discovery of cardiac catheterisation. It simply works wonder after proper pressure measurement of all cardiac chambers.

Interventional cardiologist cam cure almost half of the heart diseases beginning from congenital cardiac issues to the adult percutaneous coronary intervention by stent placement. Now percutaneous valve placement and pemnanet pacemaker implantation has kept to-be-dead people alive.

Cardiac catheterisation can be right heart catheterisation or left heart catheterisation depending on the need of suspicious diagnosis or both if required, and in complex cases it needs both.

Coronary angiography after an ECG changes can clearly diagnose the disease with aortogram with root shot of dye in aorta.

To keep the chapter short and brief almost all cardiac condition can be diagnosed with cardiac catheterisation. Pressure tracing is an important part of it with consideration of saturation in congenital cases.

Elevated RA pressure:

  • Tricuspid stenosis – large ‘a’ wave
  • Tricuspid regurgitation- large ‘v’ wave
  • RV dysfunction-pulmonary hypertension, RV infarction
  • Constrictive pericarditis
  • Tamponade
  • Restrictive disease

Elevated RV pressure:

  • RV dysfunction ( pulmonary hypertension, RV infarct)
  • Constrictive pericarditis ( square root sign; rapid x and y descent)
  • Restrictive disease
  • Cardiac tamponade ( absent ‘y’ descent)

Elevated PA pressure :

  • Mitral stenosis / Regurgitation
  • LV systolic or diastolic dysfunction ( ischaemic, dilated cardiomyopathy, aortic stenosis/regurgitation)
  • Pulmonary hypertension of other etiologies
  • Constrictive pericarditis / tamponade / restrictive disease

Elevated PCW pressure:

  • Mitral stenosis ( large ‘a’ wave if sinus rhythm)
  • Mitral regurgitation ( large ‘v’ wave)
  • LV systolic or diastolic dysfunction ( ischemic, dilated cardiomyopathy, aortic stenosis/regurgitation)
  • Constrictive pericarditis/tamponade

Elevated LVEDP:

  • LV systolic or diastolic dysfunction ( ischemic, dilated cardiomyopathy, aortic stenosis/regurgitation)
  • Constrictive pericarditis/tamponade.

So long as we manage or play safe with pressures and numbers we are safe and sure of what we treat.

History on Heart and Heart Diseases

Heart is considered as the central organ of the body since time immemorial. In fourth century B.C. the Greek philosopher Aristotle identifies heart as the centre of vitality in the body, the first to form according to his observations on chick embryos.

In second century A.D. Galen in his writings had described about the common beliefs of heart as the source of body’s innate heat and the organ most closely related to soul. He argued that the expansion and contraction of the heart was a function of its role as an intelligent organ. According to him, heart is a hard flesh which is not easily injured.In hardness, tension, strength and resistance it overpowers all others and no other organ work such continuously as heart does.

Avicenna, in his Canon of Medicine, mentioned heart as the vital power or innate heat within the body. He identified the pulse as a movement in the heart and arteries which takes the form of alternate expansion and contraction.

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At the time of renaissance people come to know about the actual structures of heart having four chambers. Leonardo Da Vinci with his great artistic observations drawn the heart with a great accuracy. He had investigated the coronary arteries.

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William Harvey who was the physician of King Charles-I, has discovered how blood moves from the right ventricle through the lung and into the aorta, then peripheral vessels and back into the lung. The French philosopher Rene Descartes, who has accepted Harvey’s theory and too his ideas a step further he has described heart as a pump and specifically a combustion engine.

Heart diseases are now the number one killer in the world as hundreds of thousands suffer from non-fatal heart attack. This disease of heart attack has always plagued the human race. Narrowing of arteries and deposition of atherosclerosis plaque because of the cholesterol deposits has always affected the humans whether now or then at the Egyptian times. Egyptian mummies, some 3500 years old had evidence of atherosclerosis according to researchers. This can be because of the high class Egyptians eating a lot of fatty meats from cattle, ducks and geese, and using a lot of salt for food preservation.

Angina, literally meaning tightness in the chest, is often an indicator of heart disease which has puzzled many physicians. First described in 1768, it was believed to be because of the narrowing of coronary arteries, thought others thought it was a harmless condition. William Osler has studied extensively on angina. James B. Herrick concluded that the slow, gradual narrowing of the coronary arteries could be a cause of angina. He is credited for invention of the term “heart attack.”

In twentieth century a lot of studies were conducted on heart and many insides were revealed in details. Doctors began to experiment with coronary arteries with catheters. The credit of first cardiac catheterisation goes to German physician Werner Forssman (1904-1979) who experimented on himself. In 1948, National Heart Institute initiated the Framingham Study, the first major study to understand heart disease. In 1949, the term arteriosclerosis was added to the International Classification of Diseases.

In 1960s and ’70s coronary artery bypass surgery and angioplasty were started to treat heart disease. In 1980s use of stents to open of narrow arteries become common practice. Now we know how to treat narrowed arteries and lengthen and improve quality of life. Though we have learned from the Egyptian mummies, Leonardo Da Vinci’s paintings, and reached a lot ahead but still we don’t know it all.