The 'right' way to do a RHC. @RyanTedfordMD Self-described "hemodynamic nerd." Welcome to @UHhospitals!! #HeartFailureGRs @UHhospitals @CWRUSOM 
The birth of modern-day hemodynamics. @RyanTedfordMD
"What the heck do we do with this patient?" Both PH and heart failure? @RyanTedfordMD
Doing a right heart catheterization correctly: before you begin!! Calibrate and position comfortably. @RyanTedfordMD #HeartFailureGRs @UHhospitals
"I almost always only use local anesthesia." @RyanTedfordMD Patients who fall asleep can face challenges, and for those with sleep apnea, this can disrupt hemodynamic measurements.
"We have a ruler in our cath lab." @RyanTedfordMD
Dr. Tedford is challenging the occasional practice of doing breath-hold maneuvers. Can result in valsalva. @RyanTedfordMD
Tip to reduce catheter ringing: introduce some blood or contrast into the catheter to reduce ringing. @RyanTedfordMD
Measuring the RA correctly. @RyanTedfordMD New term for me: "Z-point"!
Reminder, new definition of mPAP is now <= 20mmHg. @RyanTedfordMD
Getting the PAWP right is critical as it is the sole discriminator of pulmonary hypertension. @RyanTedfordMD #HeartFailureGRs @UHhospitals @CWRUSOM
In the example on the right, high pressures; "Mean PAWP represents the pressure 'felt' by the pulmonary circulation from the left atrium." @RyanTedfordMD
"The presence of large V waves should be reported as it suggests left heart disease regardless of PAWP." @RyanTedfordMD
Among obese patients end-expiratory cycle over-estimated PCWP. Best to average across the respiratory cycle. @RyanTedfordMD
Recommendations for adequate PAWP/LVEDP measurement. Ryan reports both end-expiration and averaged across the respiratory cycle. @RyanTedfordMD
Because incomplete occlusion can lead to misestimation of PCWP, at MUSC they instituted a standard of care to confirm PCWP with O2 sat measurement. @RyanTedfordMD
Checking saturation reclassifies 12% of patients!! This is now part of the guidelines in performing RHC for diagnosis of PHTN. @RyanTedfordMD #HeartFailureGRs @UHhospitals @CWRUSOM
Final take home points.
What if you 'can't' get a wedge pressure? Almost always can get PCWP if a partially deflate the balloon and... push.
What if you 'can't' get a wedge pressure? Almost always can get PCWP if a partially deflate the balloon and... push.
Challenges in measuring cardiac output: limitations of bot the Fick and thermodilution methods. @RyanTedfordMD #HeartFailureGRs @UHhospitals @CWRUSOM
"Thermodilution is a more accurate measure of cardiac output." Better association with mortality. @RyanTedfordMD #HeartFailureGRs @UHhospitals Harrington Heart & Vascular Institute
Contemporary definitions of #PulmonaryHypertension. @RyanTedfordMD #HeartFailureGRs @UHhospitals Harrington Heart & Vascular Institute
Who are patients who need vasodilators? Only 2 groups. @RyanTedfordMD #HeartFailureGRs @UHhospitals Harrington Heart & Vascular Institute
Here is Dr. Shumway's original data showing the dangers of PHTN in heart transplant candidates. @RyanTedfordMD #HeartFailureGRs @UHhospitals Harrington Heart & Vascular Institute
Ryan argues that using resting PAWP alone is not enough to define left heart disease. @RyanTedfordMD #HeartFailureGRs @UHhospitals Harrington Heart & Vascular Institute
What about saline loading? "No 'healthy' individuals would have increased PAWP > 18mmHg with 500cc saline." @RyanTedfordMD #HeartFailureGRs @UHhospitals Harrington Heart & Vascular Institute
Recommendations regarding fluid loading. @RyanTedfordMD @UHhospitals Harrington Heart & Vascular Institute
How to do a RHC? Closing thoughts!! @RyanTedfordMD #HeartFailureGRs @UHhospitals Harrington Heart & Vascular Institute
Thank you so much @RyanTedfordMD for a fantastic talk!
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