What hemodynamic change is expected in CHF with pulmonary edema?

• A. Decreased PCWP with CHF and decreased PAP
• B. Normal PCWP with decreased PAP
• C. Increased PCWP with CHF, increased PAP
• D. Decreased PAP with CHF

Answer: (C)

In congestive heart failure with pulmonary edema, the left side of the heart fails to accept incoming blood, so left atrial pressure rises. The wedge pressure (PCWP) reflects left atrial pressure, so it increases. That elevated left-sided pressure backs up into the pulmonary veins and capillaries, raising their hydrostatic pressure and causing fluid leakage into the lungs. The same backward pressure into the pulmonary circulation also elevates the pulmonary artery pressures, so both PCWP and PAP are increased. This pattern fits cardiogenic pulmonary edema, whereas normal or decreased wedge pressures or a decreased PAP would not explain the edema.