With CVP 12, PAWP 20, and SVR 1200, which condition is most consistent with the hemodynamic pattern described?

• A. Hypovolemic shock
• B. Septic shock
• C. Anaphylactic shock
• D. Congestive heart failure

Answer: (D)

This pattern reflects elevated filling pressures with a compensatory increase in vascular tone, which points to pump failure with congestion. When the heart cannot pump effectively, pressures back up into the venous system and the left-sided filling pressure rises, shown by a high PAWP. The elevated CVP indicates venous congestion on the right side as well. To maintain blood pressure in the face of reduced forward flow, systemic vascular resistance tends to increase, which is why SVR is at the higher end of normal. In contrast, hypovolemia would show low filling pressures; septic or anaphylactic states typically have reduced SVR due to vasodilation and often normal or low filling pressures. Therefore, the hemodynamic pattern here is most consistent with congestive heart failure.