Pulmonary Artery Catheter Findings

During chairmans rounds last week, we talked about shock being inadequate tissue perfusion.
In cardiogenic shock, cardiac pump failure is the etiology of shock. The pulmonary artery catheter comes
in handy when differentiating cardiogenic shock from hypovolemic and septic shock.

If the heart is the cause for poor tissue perfusion, pulmonary capillary wedge pressure tends to
be high in the setting of low cardiac output and high systemic vascular resistance. Heres a great table
illustrating the differences in pulmonary artery catheter findings for the various types of shock:

Table 1. Profiles of shock on pulmonary artery catheter in adults. (Uptodate, 2017)

The catheter will also give us right atrial pressure tracings that can suggest specific causes for
the cardiogenic shock. A physiologic tracing looks like this:

Figure 1. Physiologic right atrial pressure tracing (Uptdate, 2017)

 Patients can have a whole host of causes for cardiogenic shock. For example, patients with
tricuspid regurgitation will have blood flowing back into the right atrium during ventricular systole,
which will cause tall v waves on the right atrial pressure tracing:

Figure 2. Right atrial pressure tracing in a patient with tricuspid regurgitation. (Uptodate, 2017)

As you can see, the pulmonary catheter gives multiple data points that can suggest a specific
etiology of shock. With this information, we would be able to say with more confidence whether our
patient had cardiogenic shock or not and direct our treatment in the right direction.

-Jake Jacob