Adult Critical Care Specialty (ACCS) Practice Exam

What condition should the ACCS report if a patient displays elevated PAP and PCWP values, along with hypotension and hypoxemia?

1. Hypervolemia

2. Congestive heart failure

3. Cor Pulmonale

4. Pulmonary hypertension

The correct answer is: Pulmonary hypertension

When a patient presents with elevated pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP), along with hypotension and hypoxemia, the most appropriate condition to report is pulmonary hypertension. Pulmonary hypertension is characterized by increased pressures in the pulmonary arteries, which can lead to right ventricular dysfunction and subsequent systemic effects, including hypotension. The elevation of PAP indicates that there is a resistance to blood flow in the pulmonary circulation, which aligns with the decreased oxygen levels (hypoxemia) as the right side of the heart struggles to manage the increased workload. The elevated PCWP suggests that there may be fluid backing up into the pulmonary circulation, potentially contributing to the hypoxemia due to impaired gas exchange. In contrast, while hypervolemia can increase pressures within the circulation, it does not specifically explain the combination of symptoms noted. Congestive heart failure is characterized by similar findings but typically involves more systemic signs and symptoms of fluid overload beyond just the specific pressures noted. Cor Pulmonale, though related to right heart failure secondary to pulmonary issues, is a consequence rather than a primary condition in this scenario. This combination of elevated PAP and PCWP, hypotension, and hypoxemia strongly points toward pulmonary hypertension as