Renee Kulkarni MD May 19, 2021:

These are cardiac filling pressures -see here:
https://www.sciencedirect.com/science/article/pii/S147202992...

Bettina Grieser Johns (asker) Mar 9, 2021:

Thank you so much, Anne... ... for your explanation, now it makes perfect sense - and so does Steffen's remark that the + should be between the two, not on the 28 mmHg. Sometimes it is difficult to differentiate between source errors and intentional wording/signing. Thanks again to all of you!

Steffen Walter Mar 9, 2021:

Thank you, Anne ... ... for your explanation/summary, which is very helpful.

Anne Schulz Mar 9, 2021:

PAP and CVP Let me sum up the previous contributions (assuming this report is based on echokardiography findings rather than invasive catheterization): Doppler echokardiography does not measure absolute pressures, but only pressure differences across cardiac valves. Here, 28mmHg would be the pressure difference between right atrium and right ventricle. The tricuspid valve is the "border" between the central venous system (ends with right atrium) and the pulmonary arterial system (starts with the right ventricle). Absolute pulmonary arterial pressure (equivalent to right ventricular pressure) would therefore be equal to the (unknown) absolute pressure in the right atrium (or CVD) plus the pressure difference measured at the tricuspid valve. HTH!

Edier Quintana Mar 7, 2021:

ZVP (central venous pressure) and tricuspid valve. ZVD stands for central venous pressure; that is, the pressure in the VENA CAVA. The vena cava is connected to the right atrium; then between the right atrium and the right ventricle is the tricuspid valve. Finally, the pulmonary artery is connected to the right ventricle. Unlike the other arteries, the pulmonary artery carries UNOXYGENATED BLOOD to the lungs.
Thus, everything is interconnected, any disorder in the tricuspid valve will affect ZVD (CVP) and pulmonary artery pressure.

Steffen Walter Mar 7, 2021:

I think that ... ... CVP is in the normal range because no separate figure is mentioned in this case. And the plus sign should have been placed directly before "ZVD" (i.e. "28 mmHg +ZVD").

Bettina Grieser Johns (asker) Mar 7, 2021:

Ah, that makes sense - because the + was closer to the mmHG, I assumed it meant "above" 28 mmHG, but if you say this is fairly common in German reports... Do the two pressures actually add up to something or is it just to say, CVP is normal?

Steffen Walter Mar 7, 2021:

Different explanation Alternatively, the cardiologist may have assumed a "standard" CVP level, which usually ranges from 2 to 4 mmHg, and "symbolically" added it to the sPAP without measuring it separately. See https://eref.thieme.de/ebooks/1138531#/ebook_1138531_SL47465...

At any rate, the notation "+ZVD" appears to be fairly common in German reports.

Bettina Grieser Johns (asker) Mar 7, 2021:

Or... ... it is another error, this time one of omission. I guess we'll never know. Thanks for all your help on this!

Steffen Walter Mar 7, 2021:

Perhaps ... ... it is mentioned elsewhere or has been taken to be a "fixed" value (to be added to sPAP) based on prior measurements.

Bettina Grieser Johns (asker) Mar 7, 2021:

That would make sense, but if they measure both, why mention only one result?

Renee Kulkarni MD Mar 7, 2021:

Am citing from the linked article, Bettina:
‘It is possible to gain insight into the right and left ventricular preload following the insertion of a central venous catheter and pulmonary artery catheter to measure central venous pressure and pulmonary capillary wedge pressure, respectively. Abnormal measurements can indicate a pathophysiological state and guide management.’

Steffen Walter Mar 7, 2021:

See also ... ... https://www.thieme-connect.de/media/10.1055-b-002-101342/loo... and https://www.thieme-connect.de/media/10.1055-b-002-101342/loo... as well as https://pubmed.ncbi.nlm.nih.gov/7270386/ for a link to tricuspid valve insufficiency.

Steffen Walter Mar 7, 2021:

They measure ... ... both arterial and venous pressure levels in order to get the big picture, as it were. These pressures are interdependent - see https://www.cvphysiology.com/Blood Pressure/BP006

Bettina Grieser Johns (asker) Mar 7, 2021:

I'm probably rather slow this morning, but I still don't see the connection - as far as I can tell from both of your references, PAP and CVP are two different things, so why are they mentioned here in the same sentence? If 28 mmHG+ is PAP, why mention CVP at all? Is something missing here? I just don't get it.

Steffen Walter Mar 7, 2021:

ZVD = zentralvenöser Druck / zentraler Venendruck ... i.e. central venous pressure (CVP). See, for example, https://www.cvphysiology.com/Blood Pressure/BP020

Renee Kulkarni MD Mar 7, 2021:

These are cardiac filling pressures -see here:
https://www.sciencedirect.com/science/article/pii/S147202992...

Bettina Grieser Johns (asker) Mar 7, 2021:

@Renee Thanks, Renee, but what has ZVD got to do with it?