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Case: 84 yo woman w/long-standing HFpEF admitted for volume overload. Baseline Cr 2.0 mg/dl. Diuresed 1L on hospital day #1 and Cr 
to 2.5 mg/dl. Inpatient team stopped diuresis. Given equivocal volume status -> right heart cath. PCWP reported as 10 mmHg. What would u do next?
to 2.5 mg/dl. Inpatient team stopped diuresis. Given equivocal volume status -> right heart cath. PCWP reported as 10 mmHg. What would u do next?
Options:
Diurese further. End-expiratory PCWP was 27 mmHg. She was breathing spontaneously (not on ventilator). End-expiratory RA pressure was 16 mmHg. Diuresed net negative 8L further, Cr 2.6 upon discharge from hospital.
Pts with HFpEF often have concomitant obesity and/or chronic lung disease which can cause wide swings in intrathoracic pressure so it’s important to measure invasive hemodynamics at end-expiration. And always look at the tracings yourself!
