Postural Changes During Right Heart Catheterization
Postural Changes During Right Heart Catheterization
Hemodynamic measurements obtained during pulmonary artery catheterization are essential for
 the diagnosis and classification of pulmonary hypertension. Traditionally, right heart
 catheterization (RHC) is done in the supine position. Cardiac output is known to change
 significantly based on position, due to the effects of gravity on venous return. There has
 not been a systematic investigation into these postural effects on pulmonary arterial
 pressures nor their effect on the diagnosis of pulmonary hypertension. It is our intent to
 study the differences in measurements obtained during RHC when the patient is supine, seated,
 and standing.
The investigators also plan a prospective study of patients referred for pulmonary artery
 catheterization at the UNC cardiac catheterization lab for evaluation of known or suspected
 pulmonary hypertension. The purpose of this portion of the study is to evaluate the degree to
 which digital reading of pulmonary artery pressure (PAP) and pulmonary capillary wedge
 pressure (PCWP) impact the diagnosis and classification of pulmonary hypertension
 specifically in patients being evaluated for pulmonary hypertension while being tested in the
 supine, sitting and standing positions.

 The investigators will identify 60 patients referred for right heart catheterization to
 evaluate known or suspected pulmonary hypertension. Patients will have right heart
 catheterization performed by the clinician that was planning on performing the procedure and
 a pulmonary hypertension specialist in the Division of Pulmonary and Critical Care Medicine
 or Division of Cardiology. After informed consent is obtained, the subject will be prepped
 and draped per protocol in the UNC Cath lab. Their internal jugular vein will be visualized
 by ultrasound and accessed with a pulmonary artery catheter using standard procedure which
 also uses fluoroscopy to ensure correct placement of the catheter. Once pressure measurements
 are obtained from the cardiac chambers and pulmonary arteries, the catheter will be secured
 into place with tegaderm to allow for mobilization of the patient. The patient will then be
 asked to sit up on the side of the cath table and the pressure transducer will be
 re-calibrated to be at the level of the patient's right atrium. Repeat measurements will be
 obtained of the pulmonary artery and PCWP in this position. After, the patient will be asked
 to stand up and the pressure transducer once again re-calibrated to estimate the level of the
 right atrium; new measurements will be obtained in the standing position. Each position will
 be maintained for 5 minutes before measurements are taken. The supine position measurement
 will be used for clinical decision making purposes as per usual. The investigators will
 collect each measurement over at least 10 cardiac cycles and use the mean end-expiratory
 values to ensure precision.

 Once all measurements are obtained, the patient will be asked to return to the supine
 position. The tegaderm will be released and the catheter removed during sustained expiration
 maneuver per standard protocol.

 No sedation will be administered to the patients.

 No further contact will be done with the study subject for the purpose of this research
 trial.
Inclusion Criteria:

 -  All patients that are 18 years or older regardless of gender or race,

 -  are referred for RHC for evaluation of possible Pulmonary Arterial Hypertension (PAH)

 -  provide informed consent

 Exclusion Criteria:

 -  Inability to obtain pulmonary artery pressure or PCWP