A mean wedge pressure on a catheter report hides the waveform behind it. Large V waves can come from mitral regurgitation, but also from a small, stiff left atrium, and they raise pulmonary artery pressure without any disease in the lung vessels. Ask to see the trace, note where the wedge was measured, and interpret pulmonary vascular resistance with the V wave in mind.
- Check where in the cycle the wedge pressure was read.
- Look for a large V wave before attributing high PA pressure to pulmonary vascular disease.
- Consider left atrial stiffness when a big V wave appears without significant mitral regurgitation.
Why it matters
The label on a catheter report can steer a patient towards drugs that do not fit their physiology.
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