Chapter 15 Restrictive Cardiomyopathy David P. McLaughlin, David P. McLaughlinSearch for more papers by this authorGeorge A. Stouffer, George A. StoufferSearch for more papers by this author David P. McLaughlin, David P. McLaughlinSearch for more papers by this authorGeorge A. Stouffer, George A. StoufferSearch for more papers by this author Book Editor(s):George A. Stouffer MD, George A. Stouffer MDSearch for more papers by this author First published: 01 October 2007 https://doi.org/10.1002/9780470692608.ch15 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Summary This chapter contains section titled: Introduction Hemodynamic principles Differentiating restrictive cardiomyopathy from constrictive pericarditis Echocardiography References Cardiovascular Hemodynamics for the Clinician RelatedInformation

Chapter 5 The atrial waveform David P. McLaughlin, David P. McLaughlinSearch for more papers by this authorGeorge A. Stouffer, George A. StoufferSearch for more papers by this author David P. McLaughlin, David P. McLaughlinSearch for more papers by this authorGeorge A. Stouffer, George A. StoufferSearch for more papers by this author Book Editor(s):George A. Stouffer MD, George A. Stouffer MD Henry A. Foscue Distinguished Professor of Medicine Chief of Cardiology University of North Carolina School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorJ. Larry Klein MD, J. Larry Klein MD Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USASearch for more papers by this authorDavid P. McLaughlin MD, David P. McLaughlin MD Harrisonburg Medical Associates, Harrisonburg, VA, USASearch for more papers by this author First published: 31 December 2016 https://doi.org/10.1002/9781119066491.ch5 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShareShare a linkShare onFacebookTwitterLinked InRedditWechat Summary The right atrial (RA) waveform is measured directly with a fluid-filled pressure catheter. The left atrial waveform can be measured directly by transeptal atrial puncture or more commonly indirectly via a balloon- tipped pulmonary artery catheter. In most cases, the pulmonary capillary wedge pressure (PCWP) accurately reflects mean left atrial (LA) pressure; however, the pressure wave deflections are delayed and damped on a PCWP tracing compared to LA pressures. Elevations in RA pressure are often a clue to cardiovascular pathology. Abnormalities in the X descent are seen with severe tricuspid regurgitation (TR) or mitral regurgitation (MR) when the X descent and C wave can be interrupted by a prominent V wave. Physical examination of jugular venous pulse (JVP) provides valuable information to clinicians, as the JVP is a manometer of pressure in the right atrium. JVP can be used to assess right heart filling pressures and the waveform can provide information suggestive of specific diagnoses. Cardiovascular Hemodynamics for the Clinician, Second Edition RelatedInformation

The effect of the contrast agent iohexol on reference vessel size in patients with proximal left anterior descending disease is unknown. Quantitative coronary angiography and intravascular ultrasound were performed in 15 patients with atherosclerotic disease of the proximal left anterior descending. Mean proximal reference vessel diameter was 2.95 +/- 0.59 mm with quantitative coronary angiography and 4.65 +/- 0.66 mm with intravascular ultrasound (P < .05). Intracoronary injection of iohexol resulted in a significant decrease in intravascular ultrasound-measured proximal reference vessel diameter from 4.65 +/- 0.66 mm to 4.47 +/- 0.68 mm (P = .002). Vasoconstrictive response to iohexol in the proximal reference vessel ranged from -0.04 mm to 0.5 mm with a mean of 0.18 +/- 0.16 mm. This study shows that iohexol can cause significant vasoconstriction of the proximal reference vessel in patients with severe disease involving the proximal left anterior descending.

HomeCirculationVol. 112, No. 17Renal Fibromuscular Dysplasia Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBRenal Fibromuscular Dysplasia D. P. McLaughlin, MD, R. V. Kelly, MD, R. A. Santa-Cruz, MD and G. A. Stouffer, MD D. P. McLaughlinD. P. McLaughlin From the Division of Cardiology, University of North Carolina, Chapel Hill, NC. , R. V. KellyR. V. Kelly From the Division of Cardiology, University of North Carolina, Chapel Hill, NC. , R. A. Santa-CruzR. A. Santa-Cruz From the Division of Cardiology, University of North Carolina, Chapel Hill, NC. and G. A. StoufferG. A. Stouffer From the Division of Cardiology, University of North Carolina, Chapel Hill, NC. Originally published25 Oct 2005https://doi.org/10.1161/CIRCULATIONAHA.104.520643Circulation. 2005;112:e278–e279A 70-year-old woman was admitted with chest pain and hypertension. Her systolic blood pressure had been measured at >160 mm Hg on multiple occasions despite treatment with 4 antihypertensive medications. Selective renal angiography demonstrated bilateral beaded appearance, right greater than left, consistent with fibromuscular dysplasia (Figure, A). Imaging with intravascular ultrasound showed that the proximal vessel was normal (Figure, B), whereas the mid-vessel had an intraarterial membrane (arrow) with evidence of 2 distinct lumens (Figure, C). A comparison of pressure distal in the right renal artery (measured using a 0.014-in pressure wire) with aortic pressure showed peak systolic and mean transrenal pressure gradients of 24 and 9 mm Hg, respectively (Figure, D). Angioplasty performed using a 6-mm balloon resulted in interruption of the membrane (Figure, E) with resolution of the pressure gradient (Figure, F). Medial dysplasia, which results in the "string of beads" appearance on angiography, is the most common form of fibromuscular dysplasia in adults. Thickened fibromuscular membranes are common. Download figureDownload PowerPointAngiography of right renal artery performed in anteroposterior projection (A). Transrenal pressure gradient measured before (D) and after (F) balloon angioplasty. Intravascular ultrasound imaging performed of proximal section (B) and mid-section (C, E) of right renal artery.This case demonstrates that interruption of membrane(s) with balloon angioplasty can improve renal hemodynamics and suggests a mechanism to explain the therapeutic effect of balloon angioplasty in medial dysplasia.FootnotesCorrespondence to George A. Stouffer MD, Division of Cardiology, University of North Carolina, Chapel Hill, NC 27599-7075. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Prasad A, Zafar N and Mahmud E (2009) Assessment of renal artery fibromuscular dysplasia: Angiography, intravascular ultrasound (with virtual histology), and pressure wire measurements, Catheterization and Cardiovascular Interventions, 10.1002/ccd.21968, (NA-NA), . Völk M, Staub J and Strotzer M Gefäße im Abdomen Kardiovaskuläres System, 10.1007/978-3-540-69018-4_3, (177-252) October 25, 2005Vol 112, Issue 17 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.104.520643PMID: 16246952 Originally publishedOctober 25, 2005 PDF download Advertisement SubjectsHypertension