• La fuerza es una magnitud vectorial (unidad, dirección, sentido ) que mide la Intensidad del

intercambio de momento lineal entre dos partículas o sistemas de partículas . Según una definición
clásica, fuerza es todo agente capaz de modificar la cantidad de movimiento o la forma de los materiales.
• La presión (símbolo p )[1][2] es una magnitud física que mide la proyección de la fuerza en dirección
perpendicular por unidad de superficie , y sirve para caracterizar cómo se aplica una determinada fuerza
resultante sobre una línea.
• La presión es la magnitud escalar que relaciona la fuerza con la superficie sobre la cual actúa, es decir,
equivale a la fuerza que actúa sobre la superficie.
• Las magnitudes escalares son aquellas que quedan completamente definidas por un número y las unidades
utilizadas para su medida. Esto es, las magnitudes escalares están representadas por el ente matemático
más simple, por un número. Podemos decir que poseen un módulo pero carecen de dirección.
• Su valor puede ser independiente del observador (v.g.: la masa , la temperatura , la densidad , etc.) o
depender de la posición (v.g.: la energía potencial ), o estado de movimiento del observador (v.g.: la energía
cinética ).
• Las magnitudes vectoriales son aquellas que quedan caracterizadas por una cantidad (intensidad o
módulo ), una dirección y un sentido. En un espacio euclidiano, de no más de tres dimensiones, un vector se
representa mediante un segmento orientado. Ejemplos de estas magnitudes son: la velocidad , la
aceleración , la fuerza , el campo eléctrico , intensidad luminosa , etc. )
• Según una definición clásica, fuerza es todo agente capaz de modificar la cantidad de movimiento o la forma
de los materiales.
• La fuerza es una magnitud física de carácter vectorial capaz de deformar los cuerpos (efecto estático),
modificar su velocidad o vencer su inercia y ponerlos en movimiento si estaban inmóviles (efecto dinámico).
• En este sentido la fuerza puede definirse como toda acción o influencia capaz de modificar el estado de
movimiento o de reposo de un cuerpo (imprimiéndole una aceleración que modifica el módulo o la
dirección de su velocidad .
 Magnitudes Físicas
• Es una propiedad o cualidad medible de un sistema físico , es decir, a la
que se le pueden asignar distintos valores como resultado de una
medición o una relación de medidas .
• Magnitudes escalares: aquellas que quedan completamente definidas
por un número y las unidades utilizadas para su medida. Ejemplos son:
masa , la temperatura , la densidad , energía potencial, energía cinética.
• Magnitudes vectoriales: aquellas que quedan caracterizadas por una
cantidad (intensidad o módulo ), una dirección y un sentido. Ejemplos
son: la velocidad , la aceleración , la fuerza , el campo eléctrico ,
intensidad luminosa.
• Magnitudes o Propiedades extensivas: la masa y el volumen de un
cuerpo o sistema, la energía de un sistema termodinámico, longitud
• Magnitudes o Propiedades intensivas: la densidad, la temperatura y la
presión.
Magnitudes Escalares( TEMED)

• Quedan completamente definidas por un

número y las unidades
• T emperatura
• E nergía Potencial
• M asa
• E nergía Cinética
• D ensidad
 Magnitudes Vectoriales
(VACIF)
• Se definen por una cantidad o número
(intensidad o módulo ), una dirección y un
sentido
• V elocidad
• A celeración
• C ampo Eléctrico
• I ntensidad luminosa
• F uerza
 Fuerza y Presión
• La fuerza es una magnitud física de carácter vectorial capaz de deformar los
cuerpos (efecto estático), modificar su velocidad o vencer su inercia y ponerlos en
movimiento si estaban inmóviles (efecto dinámico)
• la fuerza puede definirse como toda acción o influencia capaz de modificar el
estado de movimiento o de reposo de un cuerpo (imprimiéndole una aceleración
que modifica el módulo o la dirección de su velocidad ).
• En física , la fuerza es una magnitud vectorial que mide la intensidad del
intercambio de momento lineal entre dos partículas o sistemas de partículas .
• Según una definición clásica, fuerza es todo agente capaz de modificar la cantidad
de movimiento o la forma de los materiales.
• Actualmente, cabe definir la fuerza como un ente físico-matemático, de carácter
vectorial, asociado con la interacción del cuerpo con otros cuerpos que constituyen
su entorno.
• La presión (símbolo p ) es una magnitud física que mide la proyección de la
fuerza en dirección perpendicular por unidad de superficie , y sirve para
caracterizar cómo se aplica una determinada fuerza resultante sobre una línea.
• En el Sistema Internacional de Unidades la presión se mide en una unidad
derivada que se denomina pascal (Pa) que es equivalente a una fuerza total de un
newton actuando uniformemente en un metro cuadrado .
• La fuerza es una magnitud vectorial que mide la Intensidad del intercambio de momento lineal entre
dos partículas o sistemas de partículas . Según una definición clásica, fuerza es todo agente capaz de
modificar la cantidad de movimiento o la forma de los materiales.
• La presión (símbolo p )[1][2] es una magnitud física que mide la proyección de la fuerza en dirección
perpendicular por unidad de superficie , y sirve para caracterizar cómo se aplica una determinada fuerza
resultante sobre una línea.
• La presión es la magnitud escalar que relaciona la fuerza con la superficie sobre la cual actúa, es decir,
equivale a la fuerza que actúa sobre la superficie.
• Las magnitudes escalares son aquellas que quedan completamente definidas por un número y las unidades
utilizadas para su medida. Esto es, las magnitudes escalares están representadas por el ente matemático
más simple, por un número. Podemos decir que poseen un módulo pero carecen de dirección.
• Su valor puede ser independiente del observador (v.g.: la masa , la temperatura , la densidad , etc.) o
depender de la posición (v.g.: la energía potencial ), o estado de movimiento del observador (v.g.: la energía
cinética ).
• Las magnitudes vectoriales son aquellas que quedan caracterizadas por una cantidad (intensidad o
módulo ), una dirección y un sentido. En un espacio euclidiano, de no más de tres dimensiones, un vector se
representa mediante un segmento orientado. Ejemplos de estas magnitudes son: la velocidad , la
aceleración , la fuerza , el campo eléctrico , intensidad luminosa , etc. )
• Según una definición clásica, fuerza es todo agente capaz de modificar la cantidad de movimiento o la forma
de los materiales.
• La fuerza es una magnitud física de carácter vectorial capaz de deformar los cuerpos (efecto estático),
modificar su velocidad o vencer su inercia y ponerlos en movimiento si estaban inmóviles (efecto dinámico).
• En este sentido la fuerza puede definirse como toda acción o influencia capaz de modificar el estado de
movimiento o de reposo de un cuerpo (imprimiéndole una aceleración que modifica el módulo o la
dirección de su velocidad .
• Fuerza: Newton (m kg s-2), 1 dina = cm g s-2 = 10-5 kg m s-2 , por tanto, 1
dina = 10-5 N = 10 μN ).
• La unidad de fuerza (m kg s-2 = 1 N) es la fuerza que da a una masa de 1
kg una aceleración de 1 m por segundo, por segundo.
• Presión (stress mecánico): (Pascal :N/m2) . Por definición, la presión es
fuerza por unidad de área.
• Trabajo, energía o cantidad de Calor: (Joule Nm, o sea: m2 kg s-2).
• Potencia : (Watt; J/s , o sea : m2 kg s-3)
• Resistencia eléctrica: (ohm: V/A, o sea : m2 kg s-3 A-2)
• Resistencia Vascular: dinas s cm-5
Dinas y Unidades Wood
• La presión ejercida por una columna de mercurio de 1 mm de altura está dada por:
• 1 mmHg = 0.1 cm x 13.6 g cm-3 x 981 cm s-2 = 1333 dyn cm-2.
• En donde 13.6 es la densidad del mercurio y 981 es la aceleración debida a la gravedad; 1 dina es
la fuerza necesaria para acelerar una masa de 1 g por 1 cm por segundo por segundo; es decir :
• Dyn = cm g s-2
• L min-1 = 1000/60 cm3 s-1
• De este modo, la presión de aceleración (en dinas), dividida por el flujo, da las unidades de :
•
Definiciones. Fuerza y Presión
• Fuerza: Newton (m kg s-2), 1 dina = cm g s-2 = 10-5 kg m s-2 , por tanto, 1 dina = 10-5 N
= 10 μN ).
• La unidad de fuerza (m kg s-2 = 1 N) es la fuerza que da a una masa de 1 kg una
aceleración de 1 m por segundo, por segundo.
• La fuerza se transmite a través de un medio líquido como una onda de presión, y un
objetivo importante del cateterismo cardiaco es evaluar exactamente las fuerzas, y
de este modo, las ondas de presión generadas por las diversas cámaras cardiacas.
• Presión (stress mecánico): (Pascal :N/m2) . Por definición, la presión es fuerza por
unidad de área.
• Onda de presión : fluctuación periódica compleja en fuerza por unidad de área. Las
unidades de esta onda de presión son : dinas/cm2. 1 dina/cm2 = 10-1 N/m2 = 7.5 x 10-
4
mmHg.
• Por ejemplo, la onda de presión ventricular puede considerarse como una
fluctuación compleja periódica en fuerza por unidad de área, con un ciclo
consistente en el intervalo de tiempo a parir del inicio de una sistole al inicio de la
sistole subsecuente.
Frecuencia Fundamental
• The number of times the cycle occurs in 1 second is termed the fundamental frequency of
cardiac pressure generation.
• Thus, a fundamental frequency of two corresponds to a heart rate of 120 beats per minute
(bpm).
• any complex wave form may be considered the mathematical summation of a series of
simple sine waves of differing amplitude and frequency (Fig. 7.1).
• Even the most complex waveform can be represented by its own Fourier series, in which the
sine wave frequencies are usually expressed as harmonics, or multiples of the fundamental
frequency. For example, at a heart rate of 120 bpm, the fundamental frequency is 2 cycles
per second (Hz) and the first five harmonics are sine waves whose frequencies are 2, 4, 6, 8,
and 10 Hz.
• The practical consequence of this analysis is that, to record pressure accurately, a system
must respond with equal amplitude for a given input throughout the range of frequencies
contained within the pressure wave.
Indicaciones de Cateterismo
Cardiaco
• valvular heart disease
• chronic heart failure,
• ST-elevation myocardial infarction (STEMI), percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG),5
unstable angina or non-STEMI,6 and congenital heart disease.
Cateterismo y hospitalización
• The most common reason for postprocedural hospitalization is
• hematomas, which necessitate additional bed rest and observation.
• In addition, diagnostic findings from the procedure may require hospitalization,
• including severe left main or three-vessel disease. Other
• potential indications for postprocedure hospitalization include decompensated
• heart failure, unstable ischemic symptoms, severe aortic
• stenosis with LV dysfunction, renal insufficiency requiring further
• hydration, and need for continuous anticoagulation.
• For proficiency to be maintained,
• laboratories for adults should perform a minimum of 300
• procedures per year.
 Medición de la Radiación
• La actividad de una muestra se mide en términos del número de desintegraciones
nucleares por segundo.
• La unidad internacional de actividad de radiación es el becquerel, que es 1
desintegración/segundo.
• El rad (dosis de radiación absorbida) es una unidad que mide la cantidad de radiación
absorbida por un gramo de material tal como tejido corporal.
• La unidad internacional para dosis de radiación absorbida es el gray, que se define como los
joules de energía absorbida por 1 kg de tejido corporal. Un gray es igual a 100 rad.
• El rem (equivalente de radiación en humanos) es una unidad que mide los efectos
biológicos de tipos diferentes de radiación.
• Para determinar la dosis equivalente o dosis rem, la dosis absorbida (rads) se multiplica por
un factor que ajusta para el daño biológico causado por una forma particular de radiación.
• Para radiación beta y gamma, el factor es 1, asi que el daño biológico en rems es el mismo
que la radiación absorbida (rads).
• Para protones y neutrones de alta energía, el factor es 10, y para partículas alfa es de 20.
Exposición a Radiación
• The maximum allowable whole-body radiation dose per year for those working
with radiation is 5 roentgen-equivalents-man (rem = 50 mSv), or a maximum of
50 rem in a lifetime.
Protocolo pre-cateterismo
• Warfarin should be discontinued
• approximately 3 days before and the INR should be less than 1.8 to
• minimize risk for bleeding. An INR lower than 2.2 is acceptable for
• radial artery access.9 In patients receiving dabigatran, use of the
• medication should be discontinued 24 hours before catheterization
• in patients with normal renal function and 48 hours before in those
• with an eGFR higher than 30 and lower than 50 mL/min.
• Aspirin and/or other oral
• antiplatelet agents are continued before the procedure.
• Those with a previous history of allergy to contrast media need
• prophylaxis before the procedure.13 A recommended regimen is the
• administration of either prednisone (50 mg by mouth) or hydrocortisone
• (100 mg by intravenous push) 12 hours and immediately before
• the procedure. Cimetidine (300 mg by intravenous push or by mouth),
• a nonselective histamine antagonist, and diphenhydramine (25 to
• 50 mg by intravenous push) may also be given.
Protocolo de cateterismo
• Right-heart catheterization should include screening
• oximetric analysis, measurement of intracardiac pressures, and
• determination of cardiac output.
• Right-heart catheterization is indicated
• when a patient has LV dysfunction, heart failure, complicated
• acute myocardial infarction, valvular heart disease, suspected
pulmonary
• hypertension, congenital heart disease, intracardiac shunts,
• or pericardial disease.
Cateterismo
• The outer diameter of the catheter is specified in French units, with 1F
equaling 0.33 mm.
• Percutaneous entry into the femoral artery is achieved by puncturing the
vessel 1 to 3 cm (or one to two fingerbreadths) below the inguinal ligament
(Fig. 19-4).
• The ligament can be often palpated as it courses from the anterior superior
iliac spine to the superior pubic ramus.
• This ligament, not the inguinal crease, should be used as the landmark.
• Removal of the sheath is not usually recommended until the activated
clotting time is less than 180 seconds, unless a vascular closure device is
being used.
• In
• assessing valvular aortic stenosis, LV and aortic or femoral artery
• pressure should be recorded simultaneously with two transducers.
• In patients with
• suspected mitral stenosis, LV and wedge or left atrial pressure should
• be obtained simultaneously with two transducers.
• After coronary arteriography and left-heart catheterization have been
• completed, the catheters are removed; if manual compression is
• used, firm pressure is applied to the femoral area for 10 minutes. The
• patient should be instructed to lie in bed for several hours with the
• leg remaining straight to prevent hematoma formation. With 4F to 6F
• catheters, 2 hours of bed rest is usually sufficient, whereas use of
• catheters larger than 6F generally requires at least 3 to 4 hours.
• Direct Transthoracic Left Ventricular Puncture. The only diagnostic
• indication for direct LV puncture is to measure LV pressure and
• perform ventriculography in patients with mechanical prosthetic
• valves in both the mitral and aortic positions that prevent both
retrograde
• arterial and transseptal catheterization. Crossing of tilting disc
• valves with a catheter should be avoided because of the risk for catheter
• entrapment, occlusion of the valve, or possible dislodgment and
• embolization of the disc.
Biopsia endomiocárdica
• Complications of endomyocardial biopsy include cardiac perforation
• with tamponade, emboli (air, tissue, or thromboembolus),
• arrhythmias, electrical conduction disturbances, injury to the tricuspid
• valve, vasovagal reactions, and pneumothorax. The overall complication
• rate is between 1% and 3%; risk for cardiac perforation with
• tamponade is generally reported to be less than 0.05%.30-32 Endomyocardial
• biopsy is the most common cause of severe tricuspid regurgitation
• after cardiac transplantation.33 The use of longer sheaths
• dramatically decreases the incidence of anatomic disruption of the
• valve during biopsy.
• Systemic embolization and ventricular arrhythmias are more
• common with LV biopsy. LV biopsy should generally be avoided in
• patients with right bundle branch block because of potential for the
• development of complete atrioventricular block, as well as in patients
• with known LV thrombus.
Balón de contrapulsación
• The device is inserted through the femoral artery via the standard
Seldinger technique with the use of 7F to 8F systems so that the tip is 2
to 3 cm below the level of the left subclavian artery.
• Optimal positioning requires fluoroscopic guidance.
• Timing of the balloon using the ECG or pressure tracing is adjusted
during 1 : 2 (one inflation for each two beats) pumping so that inflation
of the balloon occurs at the aortic dicrotic notch and deflation occurs
immediately before systole.
• Such timing ensures maximal augmentation of diastolic flow and
maximal systolic unloading. Figure 19-9 displays the optimal timing of an
intra-aortic balloon pump (IABP)
IAPB
• Favorable hemodynamic effects include a reduction in LV afterload
• and improvement in myocardial oxygenation.35 IABP insertion is indicated
• for patients with angina refractory to medical therapy, cardiogenic
• shock, or mechanical complications of myocardial infarction
• (including severe mitral regurgitation and ventricular septal defect)
• or for those who have severe left main coronary artery stenosis. An
• IABP may also be valuable in patients undergoing high-risk PCI or
• after primary angioplasty in the setting of acute myocardial infarction.
• 36 IABP insertion is contraindicated in patients with moderate or
• severe aortic regurgitation, aortic dissection, aortic aneurysm, patent
• ductus arteriosus, severe peripheral vascular disease, bleeding disorders,
• or sepsis.
DATOS HEMODINAMICOS
• The hemodynamic component of the cardiac catheterization procedure
• focuses on pressure measurements, measurement of flow (e.g.,
• cardiac output, shunt flow, flow across a stenotic orifice, regurgitant
• flow, and coronary blood flow), and determination of vascular resistance.
• Simply stated, flow through a blood vessel is determined by
• the pressure difference within the vessel and vascular resistance as
• described by Ohm’s law: Q = ΔP/R.
• The pressure waveform from a particular cardiac chamber is influenced
• by the force of the contracting chamber and its surrounding
• structures, including the contiguous chambers of the heart, pericardium,
• lungs, and vasculature. Physiologic variables of heart rate
• and the respiratory cycle also influence the pressure waveform.
ONDAS DE PRESION EN
CATETERISMO
• The pressure wave is transmitted from the tip of the catheter
• to the transducer by the fluid column within the catheter. Most
pressure
• transducers are disposable electrical strain gauges. The pressure
• wave distorts the diaphragm or wire within the transducer. This
energy is then converted to an electrical signal proportional to the
pressure
• being applied by using the principle of the Wheatstone bridge. This
• signal is then amplified and recorded as an analog signal.
ONDAS DE PRESION NORMALES
• whenever
• fluid is added to a chamber or compressed within a chamber, the
• pressure usually rises. Conversely, whenever fluid exits from a
• chamber or the chamber relaxes, the pressure usually falls. One
• exception to this rule is the early phase of LV diastolic filling, when
• LV volume increases after mitral valve opening but LV pressure
continues
• to decrease because of active relaxation.
PRESION ATRIAL DERECHA
• The right atrial pressure waveform has three positive deflections, the a, c, and v waves.
• The a wave is due to atrial systole and follows the P wave on the ECG.
• The height of the a wave depends on atrial contractility and resistance to RV filling.
• The x descent follows the a wave and represents relaxation of the atrium and downward
pulling of the tricuspid annulus by RV contraction.
• The x descent is interrupted by the c wave, which is a small positive deflection caused by
protrusion of the closed tricuspid valve into the right atrium.
• Pressure in the atrium rises after the x descent as a result of passive atrial filling.
• Atrial pressure then peaks as the v wave, which represents RV systole.
• The height of the v wave is related to atrial compliance and the amount of blood returning to
the atrium from the periphery.
• The right atrial v wave is generally smaller than the a wave.
• The y descent occurs after the v wave and reflects opening of the tricuspid valve and emptying
of the right atrium into the right ventricle.
• During spontaneous respiration, right atrial pressure declines during inhalation as
intrathoracic pressure falls.
• Right atrial pressure rises during exhalation as intrathoracic pressure increases.
• The opposite effect is seen when patients are mechanically ventilated.
PRESION ATRIAL IZQUIERDA Y PCP
• The left atrial pressure waveform is similar to that of the right atrium, although normal
left atrial pressure is higher because of the high-pressure system of the left side of the
heart.
• In the left atrium, as opposed to the right atrium, the v wave is generally higher than
the a wave.
• This difference is due to the fact that the left atrium is constrained posteriorly by the
pulmonary veins whereas the right atrium can easily decompress throughout the IVC
and SVC.
• The height of the left atrial v wave most accurately reflects left atrial compliance.
• In certain disease states associated with elevated PVR (hypoxemia, pulmonary
embolism, and chronic pulmonary hypertension) and occasionally after mitral valve
surgery, pulmonary capillary wedge pressure may overestimate true left atrial pressure.
ONDAS DE PRESION VENTRICULAR
• RV and LV waveforms are similar in morphology.
• They differ mainly with respect to their magnitudes.
• The durations of systole and isovolumic contraction and relaxation are longer and the
ejection period is shorter in the left than in the right ventricle.
• There may be a small (5 mm Hg) systolic gradient between the right ventricle and
pulmonary artery.
• Ventricular diastolic pressure is characterized by an early rapid filling wave, during which
most of the ventricle fills; a slow filling phase; and the a wave, which denotes atrial systolic
activity.
• End-diastolic pressure is generally measured at the C point, which is the rise in
ventricular pressure at the onset of isovolumic contraction.
• When the C point is not well seen, a line drawn from the R wave on the simultaneous ECG
to the ventricular pressure waveform is used as end-diastolic pressure.
PRINCIPIO DE FICK
• The basic principle is that flow of blood is proportional to the difference in the concentration of oxygen between arterial
and venous blood and the rate of oxygen uptake by red blood cells from the lungs (Fig. 19-12).
• The same number of red blood cells that enter the lung must leave the lung if no intracardiac shunt is present.
• Thus if certain parameters are known (the number of oxygen molecules attached to red blood cells entering the lung, the
number of oxygen molecules attached to red blood cells leaving the lung, and the number of oxygen molecules consumed
during travel through the lung), the rate of flow of these red blood cells as they pass through the lung can be determined.
• The advantage of the Fick method is that it is the most accurate method in patients with low cardiac output and tricuspid
regurgitation. It is also independent of factors that affect curve shape and cause errors in thermodilution cardiac output
(e.g., tricuspid regurgitation).
• The Fick method suffers primarily from difficulty obtaining accurate oxygen consumption measurements and an inability to
obtain a steady state under certain conditions.
• In patients with significant mitral or aortic regurgitation, Fick cardiac output should not be used.
D
a
t
o
s

n
e
Resistencia Vascular Sistémica

La Dina es una unidad de fuerza ( g cm s2) y la dina/cm2 es una unidad de presión. El cm3 x seg es la unidad de flujo.
The constant 80 is used to convert units from mm Hg/liter/
min (Wood units) to the absolute resistance units dyne-sec • cm-5.
RESISTENCIAS VASCULARES
PULMONARES
AREA VALVULAR POR GORLIN
AREA VALVULAR POR METODO DE GORLIN

En donde SEP = período de expulsión sistólica; DFP = período de

Llenado Diastólico; HR= FC.
Selección de Métodos
• El método de Gorlin esta influenciado más poderosamente por
errores en EL GC y no en el gradiente de presión.
• En estados de bajo gasto se debe de usar el METODO DE FICK.
• En casos de estenosis e insuficiencia ambos significativos de la misma
válvula, si la insuficiencia es grave, utilizar EL GC ANGIOGRAFICO; si
ambas lesiones son graves los métodos de cateterismo tienen
limitaciones.
Cálculo de Corto-circuitos

Flujo Pulmonar (PBF)

Flujo Sistémico (SBF)
Flujo Efectivo (EBF): Effective blood flow (EBF) is the fraction of mixed venous return
received by the lungs without contamination by shunt flow.
Pv02= Contenido de oxígeno venoso pulmonar
PaO2 = Contenido de oxígeno en arteria pulmonar (no confundir en este ejemplo con sa-
-turación arterial de oxígeno)
Sa02= Contenido de oxígeno en sangre arterial
Mv02= Contenido de oxígeno en sangre venosa mezclada
Cálculo de corto-circuitos

En caso de no tener medición de consumo de oxígeno, puede utilizarse la fórmula

anterior para el cálculo de cortocircuito izquierda derecha, en donde:
Sa02 = saturación de oxígeno en sangre arterial sistémica
Mv02 = saturación de oxígeno en sangre venosa mezclada o capilar pulmonar
Pv02 = saturación de oxígeno en sangre venosa pulmonar
Pa02 = saturación de oxígeno en arteria pulmonar
• The extraction of a given nutrient (or of any substance) from the circulation by a particular tissue is
expressed as the arteriovenous difference across that tissue, and the factor by which the
arteriovenous difference can increase at constant flow (owing to changes in metabolic demand) may
be termed the extraction reserve.
• For example, arterial blood in humans is normally 95% saturated with oxygen; that is, if 1 L of blood
has the capacity to carry approximately 200 mL of oxygen when fully saturated, arterial blood will
usually be found to contain 190 mL of oxygen per liter (190/200 95%).
• Venous blood returning from the body normally has an average oxygen saturation of 75%; that is,
mixed venous blood generally contains 150 mL of oxygen per liter of blood (150/200 75%).
• Thus the normal arteriovenous difference for oxygen is 40 mL/L (190 mL/L 150 mL/L).
• The normal extraction reserve for oxygen is 3, which means that under extreme metabolic demand,
the body’s tissues can extract up to 120 mL of oxygen (3 40 mL) from each liter of blood delivered
(1). Thus if arterial saturation remains constant at 95%, full use of the extraction reserve will result in
a mixed venous oxygen content of 70 mL/L (190 mL/L 120 mL/L) or a mixed venous oxygen
saturation of 35% (70/200 35%).
Principio de Fick
• the total uptake or release of any substance by an organ is the
product of blood flow to the organ and the arteriovenous
concentration difference of the substance.
• For the lungs, the substance released to the blood is oxygen, and the
pulmonary blood flow can be determined by knowing the
arteriovenous difference of oxygen across the lungs and the oxygen
consumption per minute.
Uso Clínico con las ondas de presión
con el catéter de flotación
1. Diagnóstico de trastornos cardiovasculares con
análisis de la morfología de las ondas de
presión
2. Evaluación de la precarga
3. Diagnóstico y manejo del edema pulmonar
PRESIONES EN AD
• Analysis of the atrial pressure tracing begins with identification of the electrical P wave.
• The first positive-pressure wave to follow the P wave is the a wave. The right atrial a wave usually is seen at the beginning
of the QRS complex, provided that atrioventricular conduction is normal (see Fig. 13-5).
• When visible, the c wave follows the a wave by an interval equal to the electrocardiographic PR interval (see Fig. 13-5).
• The peak of the right atrial v wave normally occurs simultaneously with the T wave of the electrocardiogram, provided
that the QT interval is normal (see Fig. 13-5).
• the Pra may exceed the Ppw in patients with RV failure due to increased pulmonary vascular resistance (PVR) or RV
infarction.
• In the absence of tricuspid stenosis or regurgitation, mean Pra approximates
• RVEDP. However, there is only a modest correlation between Pra and right ventricular end-diastolic volume (RVEDV), and
the Pra required for optimal filling varies
• among patients.38,39
PRESIONES EN ARTERIA PULMONAR
• Like the right atrial v wave, the pulmonary artery systolic wave typically
coincides with the electrical T wave (see Fig. 13-5).
• The pulmonary artery diastolic pressure (Ppad) is recorded as the pressure just
before the beginning of the systolic pressure wave.
• large capillary reserve normally offers such slight resistance to runoff during
diastole that the difference between the Ppad and the Ppw (the Ppad–Ppw
gradient) is 5 mm Hg or less.
• Increased pulmonary vascular resistance (PVR) causes the Ppad–Ppw gradient to
widen, whereas an increase in left atrial pressure results in a proportional rise in
the Ppad and Ppw.41,42
• Therefore, the Ppad–Ppw gradient is used to differentiate pulmonary
hypertension due to increased PVR from pulmonary venous hypertension.
PRESIONES DE CUÑA PPW
• in the Ppw tracing, the a wave usually appears after the QRS complex, and the v wave is seen
after the T wave (see Fig. 13-5).
• Thus the systolic pressure wave in the pulmonary artery tracing precedes the v wave of the Ppw
tracing when referenced to the electrocardiogram.
• An appreciation of the latter relationship is critical when tracings are being analyzed to ensure that
balloon inflation has resulted in a transition from an arterial (Ppa) to an atrial (Ppw) waveform and
to detect the presence of a “giant’’ v wave in the Ppw tracing (see below).
• Overwedging is recognized by a progressive rise in pressure during balloon inflation and usually
results from the balloon trapping the tip against the vessel wall.
• In the absence of pulmonic valve insufficiency or prominent a or v waves that increase its mean
value,
• thePpw should be equal to or less than the Ppad.
• Therefore, incomplete wedging always should be suspected if the Ppw
• exceeds the Ppad.
DIFERENCIA EN LA INSCRIPCION DE
LAS ONDAS
• Presión en AD: la onda a aparece simultáneamente al QRS y la onda v
simultáneamente a la onda T.
• PRESION EN TAP: su onda sistólica se inscribe simultáneamente a la
onda T (como la v de la presión atrial derecha)
• PRESIÓN CAPILAR PULMONAR: la onda a se inscribe DESPUES del
QRS, y la onda v DESPUES de la onda T.
Insuficiencia Mitral
• La onda sistólica de arteria pulmonar y la onda v se generan
simultáneamente, sin embargo, la onda v se desplaza retrógradamente
a través de la vasculatura pulmonar a la punta del catéter.
• De esta manera, cuando el trazo de presión se referencía al ECG, la
onda v se observará mas tardíamente en el ciclo cardiaco que la onda
sistólica pulmonar.
• En presencia de una onda v gigante, la presión diastólica de arteria
pulmonar es menor que la cuña promedio, y la presión media puede
cambiar minimamente en la transición de presión pulmonar a cuña,
dando la falsa impresión que el catéter no ha encuñado.
Ondas v izquierdas
• when the left atrium is markedly dilated, severe valvular regurgitation may give
rise to a trivial v wave, especially when there is coexisting hypovolemia.
• The important effect of left atrial compliance on the size of the v wave was
demonstrated by a study that simultaneously evaluated the height of the v wave
and the degree of regurgitation, as determined by ventriculography.
• One-third of patients who had large v waves (>10 mm Hg) had no valvular
regurgitation, and a similar percentage of patients with severe valvular
regurgitation had trivial v waves.
• Hypervolemia is a common cause of a prominent v wave.
• Another cause of a large v wave is an acute ventricular septal defect because the
increased pulmonary blood flow enhances filling of the left atrium during
ventricular systole.
Ondas V derechas
• With tricuspid regurgitation, there is often a characteristically broad v (or
cv) wave in the central venous (right atrial) tracing (Fig. 13-21).
• The v wave of tricuspid regurgitation generally is less prominent than the v
wave of mitral regurgitation, probably because the systemic veins have a
much greater capacitance than do the pulmonary veins.
• One of the most consistent findings in the Pra tracing of patients with
tricuspid regurgitation is a steep y descent.
• The latter often becomes more pronounced with inspiration (see Fig. 13-
21).
• Kussmaul’s sign, an increase in Pra with inspiration, also is observed
commonly in patients with severe tricuspid regurgitation.
Infarto de Vd y registro
• RV infarction may complicate an inferoposterior myocardial infarction.
• Common findings include hypotension with clear lung fields, Kussmaul’s sign, positive
hepatojugular reflux, and a Presión de AD that equals or even exceeds the Ppw.
• The Pra tracing in RV infarction often reveals prominent x and y descents, and these
deepen with inspiration or volume loading.
• With RV infarction, the RV and pulmonary artery pulse pressures narrow, and with RV
failure, the RVEDP may approximate the Ppad (Fig. 13-22).
• This, together with the frequent presence of tricuspid regurgitation, may lead to
difficulties in bedside insertion of the PAC, and fluoroscopy may be required.
• TEP: massive pulmonary embolism is characterized by a significant increase in the
Ppad–Ppw gradient,whereas the latter is unaffected by RV infarction. TEP presion
diastolica pulmonar >>>>pcp.
Taponamiento
• Intrapericardial pressure is a function of the amount of pericardial fluid, pericardial
compliance, and total cardiac volume.
• The x descent is preserved in tamponade because it occurs in early systole when blood is
being ejected from the heart, thereby permitting a fall in pericardial fluid pressure.
• In contrast, the y descent occurs during diastole when blood is being transferred from the
atria to the ventricles, during which time total cardiac volume and intrapericardial pressure
are unchanged.
• As a result, there is little (if any) change in Pra during diastole, accounting for the
characteristically blunted y descent of pericardial tamponade73 (Fig. 13-23).
• Attention to the y descent may prove to be quite useful in the differential diagnosis of a low
˙Qt with near equalizaton of pressures.
• An absent y descent dictates that echocardiography be performed to evaluate for possible
pericardial tamponade, whereas a well-preserved y descent argues against this diagnosis.
CMR Y PERICARDITIS
• Constrictive pericarditis and restrictive cardiomyopathy have similar
hemodynamic findings.
• Both disorders may be associated with striking increases in Pra and
Ppw due to limitation of cardiac filling.
• In restrictive cardiomyopathy the Ppw usually is greater than the Pra,
whereas in constrictive pericarditis the right and left atria exhibit
similar pressures.
• In contrast to pericardial tamponade, the y descent is prominent and
often is deeper than the x descent.