Cases

Normal study

Everything in range. Practice saying so with confidence, and notice how wide 'normal' is.

Cardiogenic shock, LV-predominant

Cold and wet: low index, low cardiac power, high wedge, compensatory vasoconstriction.

RV infarction after inferior MI

Hypotension with clear lungs: RAP at or above the wedge, PAPi below 0.9, Kussmaul physiology.

Biventricular failure

Both sides congested, output low, RAP tracking the wedge: decompensated cardiomyopathy.

Pre-capillary pulmonary hypertension

High mean PA pressure with a normal wedge and a high PVR: the pulmonary arterial bed is the problem.

Isolated post-capillary PH (HFpEF)

Pulmonary pressure raised passively by a high wedge; PVR stays normal.

Combined pre- and post-capillary PH

A high wedge and a high PVR: left-heart disease with pulmonary vascular remodeling on top.

High-output / distributive

Warm, vasodilated, high index, high SvO₂: sepsis or cirrhosis, not pump failure.

Hypovolemia

Everything low except the SVR: an empty tank, not a failing pump.

Cardiac tamponade

Diastolic equalization, low output, pulsus paradoxus, and a RA tracing that has lost its y descent.

Constrictive pericarditis

Equalized diastolic pressures with a high RAP and a W-shaped tracing: brisk x and y descents.

Mixed shock (cold and vasodilated)

Low index and low SVR together: cardiogenic shock with a distributive component.

Exertional dyspnea, echo RVSP 46 mmHg, referred to define the pulmonary pressures.

Exertional dyspnea and a dilated left atrium, referred to define the pulmonary pressures.

Former smoker with exertional dyspnea and a borderline echo estimate of pulmonary pressure.

Woman with limited scleroderma and exertional dyspnea, referred for pulmonary hypertension evaluation.

Fatigue and exertional dyspnea with a preserved ejection fraction; routine right heart catheterization.

Advanced heart failure admission with cool extremities and rising creatinine.

Atrial fibrillation, edema and abdominal distension, with severe tricuspid regurgitation on echo.

Young woman with exertional dyspnea, a systolic murmur and right heart enlargement on echo.

Dyspnea, hypotension and tachycardia in a patient with advanced cancer.

Edema, ascites and a raised jugular venous pressure that rises with inspiration.

Heart failure symptoms with thick ventricular walls on echo and low-voltage ECG.

Mild exertional dyspnea; a wedge was obtained and the balloon was inflated with an unusually small volume.

Hypotension with warm extremities and bounding pulses after fluid resuscitation.