Adult Critical Care Specialty (ACCS) Practice Exam

Which parameter would indicate right heart failure after evaluating CVP and PAP readings?

1. High CVP, low PAP

2. High PAP and high PCWP

3. Normal CVP, normal PAP

4. Low CVP, high PAP

The correct answer is: High CVP, low PAP

Right heart failure is characterized by elevated pressures in the right heart and the systemic circulation, and this can often be assessed by the Central Venous Pressure (CVP) and Pulmonary Artery Pressure (PAP) readings. A high CVP indicates increased pressure in the right atrium and systemic venous return, which can occur when the right ventricle fails to pump effectively, leading to congestion in the venous system. In this context, a high CVP paired with a low PAP suggests that the right heart is failing while the pulmonary circulation may not be significantly affected or may be compensating to some extent. Therefore, the high CVP reflects the burden on the right side of the heart, whereas a low PAP indicates that despite the right heart's dysfunction, there isn't yet significant pressure buildup in the pulmonary circulation, which would typically be seen in left heart failure or global heart failure. This combination is crucial in differentiating the nature of heart failure. A high PAP and high pulmonary capillary wedge pressure (PCWP) would indicate left heart failure rather than right heart failure, and normal CVP and PAP would suggest no heart failure. A low CVP with high PAP could indicate other conditions, such as pulmonary hypertension, rather than isolated