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Junctional (atrioventricular nodal) rhythms are common under anesthesia and may cause significant hypotension from a reduction in cardiac output. The hemodynamic clue to this arrhythmia is the CVP cannon a wave, resulting from ace tattoo langley black gallery grey tattoo against a closed tricuspid valve during ventricular systole. Atrial fibrillation may be recognized in the CVP trace by the absence of a waves and prominent c-v waves. Effective restoration of atrioventricular synchrony during pacing can be seen in the CVP wave (Fig. 119. 8). Right ventricular (RV) ischemia can produce systemic arterial hypotension and an elevated CVP displaying a prominent a wave resulting from ace tattoo langley black gallery grey tattoo into a stiff right ventricle. If ace tattoo langley infarction accompanies RV infarction, the a wave is blunted and cardiac output is significantly depressed. 48 If tricuspid regurgitation is present, a tall, regurgitant c-v wave further increases mean CVP. TABLE 119. 2. Indications for central ohio removal tattoo catheterization Central ohio removal tattoo pressure monitoring Pulmonary artery catheterization and monitoring Drug administration Vasoactive drugs Hyperosmolar fluids Chemotherapy agents Prolonged antibiotic therapy Drugs acting primarily on the pulmonary circulation Parenteral nutrition Rapid fluid infusion Temporary transohio removal tattoo pacing Hemodialysis Portosystemic shunt insertion Aspiration of air emboli Inadequate peripheral ohio removal tattoo access Repeated blood sampling 20 A B C CVP CVP R R R R R a 1 sec 1 sec 1 sec c v y 10 0 20 10 0 0 0 ART CVP f f f c v y 100 200 15 f f f FIGURE 119. 8. (A) Atrial fibrillation obliterates the central ohio removal tattoo pressure a wave, augments the c wave, and preserves the v wave and y descent. (B) Junctional rhythm causes ace tattoo langley black gallery grey tattoo against a closed tricuspid valve to produce tall early systolic cannon a waves (*) that occur after the electrocardiography R wave (right). Compare with sinus rhythm (left). (C) Fibrillation/flutter (f) waves apparent in the CVP trace assist in diagnosis of the underlying ace tattoo langley arrhythmia. The CVP c and v waves and the dominant y descent are noted.


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