Nuances in Pulmonary Hemodynamics From Left Heart Disease

In this episode of CardioNerds Rounds, Dr. Karan Desai sits down with Dr. Ryan Tedford, a leading authority in right ventricular coupling and pulmonary hemodynamics, to unravel the complexities of pulmonary hypertension complicating left-sided heart disease. Through a nuanced case of a woman in her late 30s with longstanding dilated cardiomyopathy, worsening dyspnea, hypotension, and Society for Cardiovascular Angiography & Interventions (SCAI) stage C heart failure shock, they analyze dynamic hemodynamics—including right atrial (RA), right ventricle (RV), pulmonary artery (PA), and pulmonary capillary wedge pressure (PCWP) tracings—and discuss tailored management strategies ranging from vasoactive medications to mechanical support and bridging to transplant via Impella 5.5. Dr. Tedford emphasizes the limits of traditional classification frameworks, the pitfalls of relying on normal lactate or diastolic pressure gradients for risk stratification, and the importance of individualized decision-making informed by real-time pressure–volume assessment and expert hemodynamic interpretation.

This podcast originally appeared on The CardioNerds.