What are the expected pulmonary artery catheterization findings in a 72-year-old woman with progressive dyspnea (shortness of breath), orthopnea (shortness of breath while supine), and signs of heart failure, including tachycardia, hypoxemia, elevated jugular venous pressure, and pitting edema?

From the Guidelines

The most likely set of findings on pulmonary artery catheterization for this patient is increased pulmonary capillary wedge pressure, elevated central venous pressure, and decreased cardiac output, indicating left-sided heart failure with possible right-sided heart failure and fluid overload. This pattern is consistent with decompensated heart failure, which the patient's symptoms and clinical presentation strongly suggest, including progressive dyspnea, orthopnea, tachycardia, hypoxemia, elevated jugular venous pressure, and pitting edema 1. The increased pulmonary capillary wedge pressure reflects the left ventricle's inability to effectively pump blood, leading to fluid buildup in the lungs. Elevated central venous pressure indicates right-sided heart failure or fluid overload, while decreased cardiac output is the hallmark of heart failure, where the heart is unable to pump blood effectively to meet the body's demands. Key considerations in managing this patient include:

• Optimizing fluid status and reducing congestion with diuretics, as guided by the patient's response and hemodynamic parameters 1
• Considering the use of vasodilators, inotropes, or mechanical circulatory support if the patient shows signs of severe heart failure or cardiogenic shock 1
• Monitoring oxygen saturation and considering non-invasive ventilation or mechanical ventilation if the patient's respiratory status deteriorates 1
• Assessing for and managing potential comorbidities and complications, such as myocardial ischemia, arrhythmias, or renal failure 1.

From the Research

Expected Pulmonary Artery Catheterization Findings

The expected pulmonary artery catheterization findings in a 72-year-old woman with progressive dyspnea, orthopnea, and signs of heart failure can be summarized as follows:

• Elevated pulmonary artery pressures and pulmonary capillary wedge pressure (PCWP) due to left ventricular dysfunction 2
• Increased right atrial pressure and right ventricular pressure due to right heart strain 2
• Decreased cardiac output and mixed venous oxygen saturation due to impaired left ventricular function 3, 4
• Elevated systemic vascular resistance (SVR) due to compensatory vasoconstriction 5

Hemodynamic Parameters

The following hemodynamic parameters may be expected:

• Elevated PCWP (>18 mmHg) indicating left ventricular dysfunction 2, 5
• Increased right atrial pressure (>10 mmHg) indicating right heart strain 2, 5
• Decreased cardiac output (<2.5 L/min/m2) indicating impaired left ventricular function 3, 4
• Decreased mixed venous oxygen saturation (<60%) indicating inadequate oxygen delivery 3, 4

Clinical Correlations

The physical examination findings of orthopnea, tachycardia, and pitting edema may correlate with the following hemodynamic parameters:

• Elevated jugular venous pressure (>10 mmHg) indicating right heart strain 2, 5
• Cool extremities and knee mottling indicating decreased peripheral perfusion 4
• Capillary refill time >2 seconds indicating decreased cardiac output 4