Level 1 Video Lecture: Volume Assessment (Part 1)

[@a7kh92]

Thank you very much for the informative illustration, waiting eagerly for part 2

[@AyEmShA]

As a cardiology Reg I found your channel extremely useful. Thank you Very much. I would certainly share this.

[@richardfisher9916]

Thank you Ayman, I'm glad you find it helpful. I work in critical care, but the lectures are aimed at anyone studying echocardiography, so great to get feedback from someone training in cardiology. Good luck in your studies.

[@hamishelliott5863]

That was great, thank you very much. Looking forward to part two!

[@p.1127]

thanks for this great lecture. ı couldn't understand one thing for years, if cvp surrogate for RAP, why is not cvp increase with normal spontaneous inspiration ? logically if we suction more blood to righ atrium, right atrial pressure must be increase ? am i wrong? İt results in a bigger problem for me, is RAP just a back up pressure for venous return or in and on itself RAP a hemodynamically valuable parameter ? is İncreased RAP good thing (more preload) or bad thing (barrier for venous return) I cant understand this concept for years

[@richardfisher9916]

Hi P, thanks for the questions. Firstly, in a dynamic state, where the blood is always flowing, it helps to think that it is differences in pressure which cause the flow and hence the change in volume. So imagine that volume is dependent upon pressure. When intra-thoracic pressure drops during spontaneous inspiration, RA pressure also drops. It is the drop in pressure which entices more blood in to the RA. You can imagine that the negative pressure aorund the RA is pullig the walls of the RA apart, creating more space for additional volume. With respect to the question about is increased RAP good or bad, I think it is maybe helpful to distance ourselves from the terms of good and bad as absolute terms. We do know that in spontaneously ventilating patients, who have normal cardiac structure/function and are not acutely unwell, RAP is usually in the low single figures. This is where we expect RAP to be in health. In general a capable heart will try to keep venous return moving on, and therefore maintain a low RAP. There are of course exceptions. Some patients may develop a stiff right ventricle with restrictive physiology (a cohort in which I have seen this is adults with repaired tetralogy of Fallot). They have elevated RV end-diastolic pressure and therefore are reliant on an elevated RAP in order to fill the RV. In these patients a low RAP would be inappropriate. As is usually the case, assessments must be made in context, and consider all of the observations together, combined with what you know about this individual patient and their current condition (i.e. what - if any - acute pathology, will be effecting their physiology).

[@yingggu7560]

am sure information is great provided by you, but the speaking is too fast and strong accent, difficult to follow....