Carotid hypertension - symptoms and causes

2021-03-16 12:00 AM

Many studies have confirmed the value of carotid hypertension. If the pressure is increased, the carotid venous pressure can help to predict central venous pressure and fluid volume status.

Description

This refers to the correlation between the carotid venous peak fluctuation level compared to the thymus angle. The carotid venous pressure is said to increase when the highest level of oscillation is greater than 3 cm from the angle of the sternum in the recumbent position of 45 °.

Carotid pressure is an indirect measurement of the pressure of the right ventricle filling. If the fill pressure increases, the carotid venous pressure increases.

It also has a prognostic correlation with pulmonary vascular pressure and is useful in assessing fluid volume and left ventricular function.

Reason

Heart failure.

Fluid volume overload.

Heart compression.

Pericardial effusion.

Pulmonary hypertension.

Mechanism

Contributing factors include:

In patients with heart failure, peripheral veins contract abnormally due to edema of the surrounding tissue and stimulation of the sympathetic system. It results in an increase in the volume of blood in the central venous system - for example, the thoracic vena cava system entering the right heart.

Volumetric fluid overload: Like any pump system, the ventricular function cannot effectively handle fluid overload in the lumen. Consequently, volume overload leads to an increase in volume and end-systolic and diastolic pressure, which is deposited back into the atria and then the carotid vein - or directly due to dysfunction. right or lung function due to left heart failure.

Right ventricular systolic dysfunction: a decrease in right ventricular ejection leads to increased end-systolic pressure, which leads to increased right atrial pressure. This pressure is then transferred back into the central venous system, increasing venous pressure and carotid venous pressure.

Impaired right ventricular diastolic function (e.g., constricting pericarditis, compression of the heart): stiffening of the ventricular wall or decreased likelihood of higher RV diastolic filling to a certain volume during work. This pressure then stagnates back into the central venous system.

Meaning

Many studies have confirmed the value of carotid hypertension.

If the pressure increases, the carotid venous pressure can help to predict the central vein pressure and fluid volume status:

Predict CVP> 8 cmH2O: sensitivity 47–92%, specificity 93–96%, LR if any 9.0.

Detect CVP> 12 cmH2O: sensitivity 78–95%, specificity 89–93%, LR if present 10.4 and if not 0.1. Another study found significant no increase in carotid venous pressure:

Predict PCWP> 18 mmHg: sensitivity 57%, PPV 95%, NPV 47%.

However, in the absence of carotid hypertension, the concreteness is 93% for PCWP <18 mmHg.

Carotid hypertension gives a negative prognosis in the following cases:

Predict newly discovered heart failure: RR 1.32.

Prediction of death from heart failure: RR 1.37.

Carotid hypertension is a core marker in pericardial diseases:

Occurs in acute cardiac compression in 100% of cases.

In 98% of patients with spasmodic pericarditis.