RA/CVP Waveform Interpretation



Central venous pressure (CVP) or right atrial pressure (RAP) waveform tracings can often times provide useful insight about a patient’s right ventricle (RV), tricuspid valve (TV), and overall cardiopulmonary status. The waveform morphology is easier to identify at slower heart rates and consists of three waves and two descents:



 - ‘a’ wave (RA contraction at end diastole): lost in atrial fibrillation/flutter due to disorganized atrial activity. ↑ in pathologies that impede forward flow like tricuspid/pulmonic stenosis and pHTN. Classic “cannon waves” caused by RA contraction against a closed TV causing reflection wave back into RA (junctional rhythm, V-tach, third degree block)

 - ‘c’ wave (TV cusps bulge into RA during early systole): c-v wave fusion and blunting of ‘x’ descent with TR

 - ‘x’ descent (RA relaxation in mid systole): ↑ in constrictive pericarditis (CP), ↓ with TR (jet ↑ RAP) and RV dysfunction due to ↓ downward movement of RV

 - ‘v’ wave (rapid filling of RA in late systole). ↑ in TR from regurgitant jet ↑ RAP. Similar tracings obtained for LEFT atrial pressures (↑ ‘v’ wave with mitral regurgitation). Success of mitral valve repair (ie, MitraClip) can be partly gauged by ↓ in ‘v’ wave.

 - ‘y’ descent (rapid RV filling in early diastole) Steep ↑ with constrictive pericarditis and ↓ with tamponade (↓ RV filling from ↓ caval inflow).



Rishi Kumar, MD @rishimd



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