American Board of Internal Medicine (ABIM) Certification Practice Exam

When is a right heart catheterization indicated in the context of PAH?

1. When diagnosing heart failure

2. When PH is believed to be related to underlying lung disease

3. For exercise testing

4. When symptoms are refractory

The correct answer is: When PH is believed to be related to underlying lung disease

Right heart catheterization is indicated in the context of pulmonary arterial hypertension (PAH) particularly when the pulmonary hypertension (PH) is suspected to be related to underlying lung disease. The procedure allows for direct measurement of pulmonary arterial pressures and the filling pressures of the heart, which is crucial in differentiating PAH from other forms of pulmonary hypertension that can occur due to lung diseases such as COPD or interstitial lung disease. In cases where PH is thought to be associated with lung disease, right heart catheterization can provide essential information that may change the management plan. This includes distinguishing between PAH and PH due to left heart disease or lung disease. The accurate measurement of pressures helps to confirm a diagnosis of PAH and aids in evaluating its severity, which is vital for guiding treatment options. Other scenarios, such as diagnosing heart failure, performing exercise testing, or addressing refractory symptoms, may warrant further investigation or management strategies but typically do not specifically require right heart catheterization to elucidate the underlying etiology in the context of suspected or confirmed PAH.