Filling Pressures in the Right and Left Sides of the Heart in Acute Myocardial Infarction

Abstract

Simultaneous measurement of central venous (CVP) and pulmonary capillary wedge (PCW) pressures were made in patients with acute myocardial infarction, on admission to the coronary-care facility and during volume expansion or diuresis. The level of PCW correlated closely with the presence or absence of radiologic pulmonary congestion. CVP, on the other hand, was of no value in assessment of the presence of congestive heart failure by radiologic criteria, and bore no consistent relation to PCW. Furthermore, CVP was not an accurate indicator of directional changes in PCW during fluid therapy. Three patients had pulmonary edema in the presence of a normal level of CVP. In disease characterized by marked differences between either compliance or function of the two ventricles, such disparities between CVP and PCW should be anticipated. Thus, CVP monitoring in acute myocardial infarction is at best of limited value, and at worst seriously misleading.