Need help - PAP, PAOP, CVP

[savyhill]

I am preparing for a certification and encounter questions about PAP, PAOP, CVP.

I work in IMCU not ICU and therefore have little contact with above measures.

I know the normal ranges but have difficulty answering for example a specific question.

Your patient with an IWMI also has RV infarction. He soon develops RV failure. Which of the following data would correlate this:

A. PAP 54/28 PAOP 14 CVP14

B. PAP 23/8 PAOP 19 CVP20

C. PAP 28/10 PAOP 10 CVP20

D. PAP 54/18 PAOP 24 CVP5

C is the correct answer and I had chosen B.

Can someone explain this to me, a good rational, what is happening here......?

[dianah, ASN]

RV failure from IWMI = weak pumping into the PA.

PA and wedge (PAOP) pressures will not rise; there is no backing up of blood or fluid to make them rise.

With the inefficient RV pump, there may be backup of blood into the RA and IVC, which would show in a high CVP reading.

As the right side of the heart is a low-pressure system, this is initially treated with IV fluids to maintain RV preload.

May see hypotension without rales (as opposed to LV failure--->rales), and bradycardia (may need pacemaker).

Google RV failure and/or IWMI hemodynamics.

Good on you, for going after certification!

Good luck! :)