Anaes Cases · Invasive monitoring
A large v wave on the CVP trace during surgery
The hot CVP-v-wave case — the sudden large v wave suggests an acute tricuspid regurgitation (from the pulmonary hypertension, the RV ischaemia, the pacing wire) or a volume overload; the management depends on the cause.
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Prompt
During a major abdominal surgery, the CVP trace suddenly develops a prominent large v wave, and the CVP rises from 8 to 20 mmHg. The blood pressure falls. Discuss the differential and the management.
Presentation
During a major abdominal surgery in a 65-year-old with a known ischaemic heart disease, the CVP trace suddenly develops a prominent large v wave (replacing the normal a-c-x-v-y pattern), and the CVP rises from 8 to 20 mmHg. The blood pressure falls from 120 to 80. The airway pressure has not changed significantly.[40457940]
References2ShowHide
- [1]Lloyd-Donald P, et al. Measurement and interpretation of central venous pressure: a narrative review. Anaesthesia, 2025.PMID 40457939
- [40457940]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.