Right and left ventricular end-diastolic pressure tracings

Simultaneous right (RV) and left ventricular (LV) pressures recordings. Panel A: A normal patient who has a junctional rhythm, accounting for the absence of the "a" wave at the end of diastole. Although the diastolic period is relatively flat for the first beat, there is normal filling by the third beat. Panel B: Elevated left ventricular end-diastolic pressure (LVEDP) in patient with impaired LV relaxation and diastolic dysfunction due to chronic mitral regurgitation. Panel C: Recorded at a scale of 0 to 100 mmHg in a patient with decompensated severe heart failure. The LVEDP is significantly elevated and there is also elevation of the right ventricular end diastolic pressure (RVEDP). In addition, the upstroke velocity of LV systole is delayed, consistent with global LV dysfunction. Panel D: Elevations in both RVEDP and LVEDP due to a cardiomyopathy. A ventricular pacemaker is also present, causing a delay and skewing in the RV diastolic relaxation period with overlapping of the LV and RV pressure downslopes. Panel E: A patient with hypertension and heart failure who has a left bundle branch block. The LVEDP is elevated and the LV pressure upslope in systole is more rapid than that of the RV. The LV is noncompliant, resulting in a rapid increase in diastolic pressure which is not seen in the RV. As in panel D, RV diastolic relaxation is delayed and overlaps with that of the LV.