Case: 64 yo man w/HFpEF, HTN, obesity, CAD, AF s/p ablation, NYHA 3. Invasive hemodynamics shown below. PCWP 11 at rest, ⬆️ to 32 with V waves up to 75 with 20W bike exercise. Only 1+ MR at rest/exercise. What caused the severe elevation in PCWP and V waves with minimal exercise?
By the way, at the time of his cardiac catheterization, his NTproBNP was only 98 pg/ml.
This pt had a very stiff LA, possibly due to AF ablation. There was no evidence of pulmonary vein stenosis on CT. He also had significant coronary microvascular dysfunction. But a stiff LA won’t cause big V waves with exercise by itself. Where did all the extra blood come from??
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