Right atrial pressure

Notes CO cardiac output VR venous return HR heart rate SV stroke volume EDV end-diastolic volume ESV end-systolic volume O blood flow AP pressure gradient R resistance r vessel radius P systolic pressure Piiastoik- diastolic pressure MAP mean arterial pressure TPR total peripheral resistance, P venous pressure Era- right atrial pressure Rv venous resistance. 

The pressure gradient, or the inflow pressure minus the outflow pressure, is determined by the pressure at the beginning of the venous system (Pv) and right atrial pressure (Prblood flow the slightly stiffer large veins offer a small degree of resistance (Rv). 

Placement of a CVP line provides a useful (although indirect and insensitive) estimate of the relationship between increased right atrial pressure and CO. 

The central venous pressure is the hydrostatic pressure generated by the blood in the great veins. It can be used as a surrogate of right atrial pressure (mmHg). 

Since Kantrovitz et al. described the concept of counterpulsation in 1968 [3], the lABP has been the mainstay for temporarily augmenting the cardiac output and improving hemodynamics in acutely decompensated refractory HF [4, 5]. lABP use has been shown to reduce heart rate, left ventricular end-diastolic pressure, mean left atrial pressure, afterload, and myocardial oxygen consumption by at least 20-30%. The lABP also modestly increases coronary perfusion pressure and decreases the right atrial pressure, pulmonary artery pressure, and pulmonary vascular resistance [6]. 

B. Intravenous furosemide causes a significant decrease in pulmonary capillary wedge pressure and right atrial pressure, concomitantly decreasing stroke volume and increasing vascular resistance. This effect in many cases occurs before diuresis begins. 

Carvedilol significantly reduces systemic blood pressure, pulmonary artery pressure, right atrial pressure, systemic vascular resistance, and heart rate, while stroke volume index is increased. 

In 142 patients with symptomatic heart failure (New York Heart Association classes III and IV) randomized to double-blind, placebo-controlled short-term treatment with a single intravenous dose of conivaptan 10, 20, or 40 mg, conivaptan significantly reduced pulmonary capillary wedge pressure and right atrial pressure and increased urine output (1). 

Hemodynamic effects During treatment with ACE inhibitors, systemic vascular resistance is decreased along with the pulmonary capillary wedge pressure and right atrial pressure (4). End-diastolic and end-systolic dimensions are reduced. Long-term ACE inhibition decreases echocardiographic left ventricle (LV) dimensions and increases the shortening fraction (5). 

In pulmonary hypertension, both verapamil and nifedipine increase mean right atrial pressure in association with hypotension, chest pain, dyspnea, and hypoxemia the severe hemodynamic upset resulted in cardiac arrest in two patients after verapamil and death in another after nifedipine (54). A patient with pulmonary hypertension also developed pulmonary edema whilst taking nifedipine (55) and another seems to have developed this as an allergic reaction (56). 

The jugular venous pressure (J VP) is used as a measure of right atrial pressure. The JVP is measured in centimeters from the sternal angle and is best visualized with the patient s head rotated to the left. The JVP is described for its quality and character, effects of respiration, and patient position-induced changes. When reporting a JVP, both the measure and the patient position must be reported. The JVP can be reported as actual centimeters above the manubrium, or... 

One form of monitoring that may take place in the emergency and operating rooms, as well as in the ICU, requires placement of a central venous pressure (CVP) line. Monitoring of CVP provides the clinician with an indirect and insensitive yet useful estimate of the relationship between increased right atrial pressure and cardiac output. ... 

RAP right atrial pressure resident assessment protocol... 

GZ caused an increase in right atrial pressure as well as thickening of the pulmonary vessels in rats suggesting pulmonary hypertension [188]. 

Halothane (Fluothane) Mechanism unclear. Induces rapid, comfortable anesthesia and skeletal muscle relaxation. i cardiac output, mild T of systemic vascular resistance, typically no effect on heart rate, 1 right atrial pressure, moderate depression of myocardial function, most likely to sensitize myocardium to catecholamines and i baroreceptor reflex. t ventilation control (T tidal volume, >1 rate of breathing, i response to CCfe and hypoxia), bronchodilation (mostpotent), No effect on hypoxic pulmonary vasoconstrictor response, depression of ciliary function and mucous clearance. 

Enflurane (Ethrane) Most potent myocardial depressant, i cardiac output, systemic vascular resistance, yet slows heart rate, t right atrial pressure, sensitizes myocardium to catecholamines. Most potent suppressor of ventilation control. Less bronchodilation than halothane. Effects on secretions similar to halothane. 

Isoflurane (Forane) Least likely to T right atrial pressure, depress myocardial function, or sensitize myocardium to catecholamines. Greatly i systemic vascular resistance. Marked T heart rate Least potent suppressor of ventilation control and bronchodilation. Marked suppression of hypoxic pulmonary vasoconstrictor response, little effect on secretions. 

Figure 1. Simplified model of the cardiovascular system. Abbreviations RA, right atrium AO, aorta R, systemic resistance P,., central venous pressure P a, right atrial pressure and P arterial pressure. (From Levy, with permission of the American Heart Assoc., Inc.)...

Guyton AC, Lindsey AW, Abernathy B, Richardson T (1955a) Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol 189 609-615... 

Herndon CW, Sagawa K (1969) Combined effects of aortic and right atrial pressures on aortic flow. Am J Physiol 217 65-72... 

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