Which of the following conditions is most likely to occur in a patient with the following hemodynamic data? Pressures: RA = 12 mm Hg, RV = 50/12 mm Hg, PA=50/15 mm Hg,PA wedge pressure = 8 mm Hg, Aoa=80/60,Cardiac Index = 1.4, SVR= 1800, PVR=500.
Correct Answer: Acute massive pulmonary embolism
Description: Normal pressure Value given ( in mmHg) Interpretation RA = 2-6 mmHg 12 Elevated RV = 25/5 mmHg 50/12 Elevated Pulmonary aery = 25/10mmHg 50/15 Elevated PCWP = 8 -12 mmHg 8 Normal Aoa = < 120/80 80/60 Hypotension The presence of Normal PCWP rules out the primary involvement of left side hea.so,Acute MI with LVF is ruled out. Hypovolemic shock following Gastroenteritis will lead to under-filling of the right side of hea but this patient has elevated pressure values on the right side of the hea. Early septic shock will lead to increased cardiac output but this patient has hypotension.(ruled out) Increased RA, PV pressure with PAH indicates RV malfunction. Less flow to lungs will lead to systemic hypotension. Hence, the patient has presentation of Acute Cor-Pulmonale.
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