Central venous pressure (CVP) measurement along with invasive arterial pressure measurement are the two most widely used monitoring parameters in the Intensive Care Unit (ICU) and in the operating room (OR).In contrast with left heart catheterization, right heart catheterization is a procedure which is performed in the daily clinical practice both in the OR and the ICU and with which all anesthesiologists are well familiarized. Despite the limited usefulness of absolute CVP values, analysis of the CVP waveform offers important information regarding patient’s underlying pathology.ECG tracing should be taken concurrently with CVP measurement and CVP should be evaluated and interpreted in relationship to the ECG. CVP values are affected by several parameters such as mechanical ventilation and PEEP application, which should be taken into account when interpreting CVP measurements. Tricuspid regurgitation (TR) is a relatively common abnormality and in most of the cases it is asymptomatic and has no clinical significance. In regard to etiology, TR can be categorized as primary (or organic) and secondary (or functional).TR allows blood to flow backwards across the valve from the right ventricle to the right atrium during right ventricle systole. When blood backflow is significant there may be giant systolic V waves in the CVP waveform. In case of severe TR, the giant systolic V waves are so prominent that the CVP waveform resembles the right ventricular pressure contour. This is called ventricularization of the right atrial pressure waveform. In contrast with the giant V waves in the CVP waveform, ventricularization of the right atrial pressure waveform is the most specific diagnostic criterion of severe TR. TR disease is diagnosed and thoroughly evaluated by echocardiography, which can give us information about its etiology and severity. However, CVP waveform may be indicative of TR and therefore could trigger further investigation and evaluation by echocardiography. Continue reading →