On a pulmonary capillary wedge pressure tracing, the presence of V waves can indicate ischemia affecting which region of the heart?

On a pulmonary capillary wedge pressure tracing, the presence of V waves can indicate ischemia affecting which region of the heart?

• A. Posterior wall of the left ventricle and posterior mitral valve
• B. Anterior wall of the left ventricle
• C. Lateral wall of the left ventricle
• D. Septal wall of the left ventricle

Answer: (A)

V waves on a pulmonary capillary wedge pressure tracing reflect mitral regurgitation, which raises left atrial pressure during ventricular systole. Ischemia that leads to mitral valve incompetence most often involves the posterior structures of the mitral valve and the posteromedial papillary muscle, which sits in the region of the posterior left ventricle. This area is supplied by the posterior descending artery, so ischemia here can impair the tethering of the posterior leaflet and cause MR, producing prominent V waves. The anterior, lateral, or septal walls are less directly linked to the posterior mitral apparatus, and their ischemia does not as reliably produce the regurgitant flow that creates those tall V waves. Thus, V waves point to ischemia affecting the posterior wall of the left ventricle and the posterior mitral valve.

V waves on a pulmonary capillary wedge pressure tracing reflect mitral regurgitation, which raises left atrial pressure during ventricular systole. Ischemia that leads to mitral valve incompetence most often involves the posterior structures of the mitral valve and the posteromedial papillary muscle, which sits in the region of the posterior left ventricle. This area is supplied by the posterior descending artery, so ischemia here can impair the tethering of the posterior leaflet and cause MR, producing prominent V waves. The anterior, lateral, or septal walls are less directly linked to the posterior mitral apparatus, and their ischemia does not as reliably produce the regurgitant flow that creates those tall V waves. Thus, V waves point to ischemia affecting the posterior wall of the left ventricle and the posterior mitral valve.