Indications PA catheter and tailored therapy

* Diagnosis and evaluation

Ddx of shock (cardiogenic vs. distributive; espec if trial of IVF failed or is high risk) and of pulmonary edema (cardiogenic vs. not; espec if trial of diuretic failed or is high risk)

Evaluation of CO, intracardiac shunt, pulm HTN, MR, tamponade, cardiorenal syndrome

Evaluation of unexplained dyspnea (PAC during provocation w/ exercise, vasodilator)

* Therapeutics (Circ 2017;136:e232)

Tailored therapy to optimize PCWP, SV, SMVO2, RAP, PVR in heart failure or shock

Guide to vasodilator therapy (eg, inhaled NO, nifedipine) in PHT, RV infarction

Guide periop mgmt in some high-risk Pts, candidacy for mech circ support & transplant

* Contraindications

Absolute: right-sided endocarditis, thrombus/mass or mechanical valve; proximal PE

Relative: coagulopathy (reverse), recent PPM or ICD (place under fluoroscopy), LBBB (~5% risk of RBBB → CHB, place under fluoro), bioprosthetic R-sided valve