A patient has the following hemodynamic values: PCWP 22 mmHg, PA systolic/diastolic 45/28 mmHg, CVP 14 mmHg, cardiac output 2.8 L/min. Which cardiac condition is MOST consistent?

• A Right heart failure with preserved left ventricular function
• B Acute left heart failure with secondary pulmonary hypertension and right heart strain ✓
• C Cardiac tamponade with equalization of filling pressures
• D Constrictive pericarditis showing square root sign

Explanation

PCWP of 22 mmHg (elevated, reflecting left heart failure/elevated LAP), elevated PA pressures with a transpulmonary gradient [(mean PA – PCWP) = ~37–22 = 15 mmHg, suggesting reactive pulmonary hypertension], elevated CVP (RV failure from PH), and low cardiac output (cardiogenic shock pattern) are consistent with acute decompensated left heart failure with secondary pulmonary hypertension causing right heart strain. In tamponade (option C), all filling pressures would nearly equalize (PCWP ≈ CVP ≈ PADP). Isolated right failure (option A) would have low PCWP.

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

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