Adult Critical Care Specialty (ACCS) Practice Exam

What does a high central venous pressure (CVP) often indicate in a critical care patient?

1. Normal heart function

2. Right heart failure

3. Left-sided heart failure

4. Pulmonary embolism

The correct answer is: Right heart failure

A high central venous pressure (CVP) is indicative of increased volume or pressure in the venous system, which often suggests that the right side of the heart is struggling to effectively pump blood. This can occur due to right heart failure, where the heart's ability to fill and/or pump blood is compromised, leading to an accumulation of blood in the venous system and thus an elevated CVP. In the context of critical care, monitoring CVP provides important insights into a patient’s hemodynamic status. Elevated CVP can also occur in fluid overload states or conditions affecting the heart's filling pressures, but right heart failure is one of the primary reasons for persistently high values, as it directly correlates with the inability of the right ventricle to handle normal venous return. Other conditions like left-sided heart failure or pulmonary embolism could alter filling pressures as well, but they usually present with different hemodynamic findings. Left-sided heart failure often leads to pulmonary congestion rather than a solely elevated CVP, which typically reflects issues on the right side of the heart. Pulmonary embolism could also influence pressures but may not always present with high CVP in every case, depending on the severity and the patient's compensatory mechanisms.