In left-sided heart failure, which hemodynamic parameter is typically elevated?

• A. Increased pulmonary capillary wedge pressure
• B. Decreased pulmonary capillary wedge pressure
• C. Normal wedge pressure
• D. Decreased venous return

Answer: (A)

Pulmonary capillary wedge pressure reflects left atrial pressure and left-sided filling pressure. In left-sided heart failure, the left ventricle can’t pump effectively, causing blood to back up into the left atrium and pulmonary veins. This backpressure raises the left atrial pressure, which is transmitted to the pulmonary capillaries, increasing the wedge pressure. The elevated PCWP correlates with pulmonary edema because the higher pressure pushes fluid into the lung interstitium and alveoli. Normal or reduced wedge pressures would not fit significant left-sided failure, and decreased venous return isn’t the characteristic driver in this scenario.