A patient with massive pulmonary embolism develops acute right heart failure. Which hemodynamic pattern would be expected on right heart catheterization?

• A Elevated pulmonary artery pressure, elevated PCWP, low cardiac output
• B Low pulmonary artery pressure, elevated PCWP, normal cardiac output
• C Low pulmonary artery pressure, low CVP, high cardiac output
• D Elevated pulmonary artery pressure, low/normal PCWP, low cardiac output, elevated CVP ✓

Explanation

Massive pulmonary embolism causes acute obstruction of the pulmonary vasculature, raising pulmonary artery pressure (PAP). The right ventricle, unable to pump against this elevated afterload, dilates and fails — raising CVP (right atrial pressure). PCWP (left heart filling pressure) is LOW or normal because blood cannot pass through the obstruction to reach the left heart, resulting in low cardiac output (cardiogenic shock). This hemodynamic pattern — elevated PAP + elevated CVP + low PCWP + low CO — distinguishes PE-related right heart failure from left heart failure.

Reference: Guyton & Hall, Textbook of Medical Physiology, 14th ed.

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