Click on image to view larger version.

Figure 3 Hemodynamic recordings from a patient with a W pattern. Peaks of W are formed by prominent A-waves, and most prominent right atrial (RA) descent occurs just before T-wave of electrocardiogram (ECG) (A). Simultaneous RA and right ventricular (RV) pressures (B) demonstrate that this prominent descent coincides with peak right ventricular systolic pressure (RVSP) and is therefore an "X" systolic descent, followed by a comparatively blunted Y descent. Peak RVSP is depressed, RV relaxation is prolonged, and there is a dip and rapid rise in RV diastolic pressure. Prominent RA A-waves are reflected in the right ventricle as an augmented end-diastolic pressure (EDP) rise (arrows). These waveform relations are confirmed by simultaneous superimposed RA/RV pressure recordings (C). Reprinted with permission from reference 9.