Pulmonary Hemodynamics and Right Heart Catheterization

Abstract

Hemodynamic assessment of the patient with pulmonary hypertension begins with a careful physical exam and is followed by several noninvasive tests and ultimately right heart catheterization. Proper interpretation of the considerable data that is generated by this process requires a firm working knowledge of the pulmonary circulation and right ventricle along with major factors that can affect pulmonary vascular tone and cardiac output. This chapter reviews normal cardiopulmonary physiology and provides an in depth approach to assessing pulmonary hemodynamics in patients with pulmonary vascular disease. A detailed discussion of the physical exam and techniques used for transthoracic echocardiogram and right heart catheterization are provided along with a guide to interpreting their results. The skills and diagnostic approaches presented are necessary for the proper diagnosis of pulmonary vascular disease and should be used to distinguish patients with pulmonary arterial hypertension from patients with pulmonary hypertension associated with left heart failure or chronic thromboembolic pulmonary hypertension.