High central venous pressure

Introduction High central venous pressure refers to a high pressure in the right atrium or in the vena cava near the right atrium. Central venous pressure (CVP) is the pressure at which the superior and inferior vena cava enter the right atrium. It is measured by the superior and inferior vena cava or right atrial cannula. It reflects the right atrial pressure and is a clinical observation of hemodynamics. One of the main indicators is that it is affected by three factors: right heart pumping function, circulating blood volume and systemic venous system vascular tone. Determination of CVP is important for understanding effective circulating blood volume and right heart function. The normal value is 0.49-1.18 Kpa (5-12 cmH2O).

Cause

Neurohumoral factors are sympathetically excited, and increased secretion of catecholamines, vasopressin, renin, and aldosterone may cause high central venous pressure. When the central venous pressure is greater than 1.47 kPa (15 cmH2O), it indicates cardiac insufficiency, excessive venous vascular bed contraction or increased pulmonary circulation resistance; if CVP exceeds 1.96 kPa (20 cmH2O), it indicates congestive heart failure.

an examination

Related inspection

Central venous pressure measurement (CVP) blood pressure cardiac output (CO)

The blood pressure in the right atrium and the large thoracic vein is called central venous pressure. The level of central venous pressure depends on the correlation between cardiac ejection capability and venous return. When the cardiac ejection capacity is weakened, the central venous pressure is increased.

On the other hand, if the venous return rate is increased, the central venous pressure will also increase. Therefore, the central venous pressure may increase in the case of an increase in blood volume, systemic venous contraction, or elevation of peripheral venous pressure due to relaxation of the micro-arteries. It can be seen that central venous pressure is another indicator of cardiovascular function.

Clinically, in the treatment of shock with infusion, in addition to observing changes in arterial blood pressure, we must also observe changes in central venous pressure. The normal range of central venous pressure is 4 to 12 cm H2O. If the central venous pressure is higher than normal and there is a trend of progressive elevation, it suggests that the infusion is too fast or the cardiac ejection function is incomplete.

Differential diagnosis

Differential diagnosis of high central venous pressure:

Pulse pressure widening: Pulse pressure difference refers to the difference between systolic blood pressure and diastolic blood pressure, and the normal range is 20-60 mmHg. Generally, it is larger than 60 mmHg, which is called pulse pressure difference increase, and less than 20 mmHg is called pulse pressure difference reduction.

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