eMedicine Specialties > Cardiology > Invasive Diagnostic, Interventional, and Surgical Procedures

Pulmonary Artery Catheterization: Multimedia

Author: Bojan Paunovic, MD, Assistant Professor, Department of Internal Medicine, Section of Critical Care, University of Manitoba; Medical Director of Critical Care, Grace Hospital, Canada
Coauthor(s): Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Contributor Information and Disclosures

Updated: Nov 18, 2009

Multimedia

A pulmonary artery catheter is shown here.
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Media file 1: A pulmonary artery catheter is shown here.
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A pulmonary artery catheter is shown here.

A pulmonary artery catheter is shown here.

The balloon of the catheter should be checked pri...
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Media file 2: The balloon of the catheter should be checked prior to insertion.
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The balloon of the catheter should be checked pri...

The balloon of the catheter should be checked prior to insertion.

Pulmonary artery catheter being introduced from p...
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Media file 3: Pulmonary artery catheter being introduced from pulmonary artery in to wedge position.
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Pulmonary artery catheter being introduced from p...

Pulmonary artery catheter being introduced from pulmonary artery in to wedge position.

Normal hemodynamic parameters.
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Media file 4: Normal hemodynamic parameters.
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Normal hemodynamic parameters.

Normal hemodynamic parameters.

Calculation of various hemodynamic parameters.
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Media file 5: Calculation of various hemodynamic parameters.
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Calculation of various hemodynamic parameters.

Calculation of various hemodynamic parameters.

Central venous pressure (CVP) measured in superio...
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Media file 6: Central venous pressure (CVP) measured in superior vena cava (SVC) is identical to right atrial pressure (RAP).
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Central venous pressure (CVP) measured in superio...

Central venous pressure (CVP) measured in superior vena cava (SVC) is identical to right atrial pressure (RAP).

Respiratory variation is easily identified on the...
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Media file 7: Respiratory variation is easily identified on the right atrial waveform.
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Respiratory variation is easily identified on the...

Respiratory variation is easily identified on the right atrial waveform.

Various waveforms of central venous pressure (CVP...
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Media file 8: Various waveforms of central venous pressure (CVP) monitoring are shown here.
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Various waveforms of central venous pressure (CVP...

Various waveforms of central venous pressure (CVP) monitoring are shown here.

Pulmonary arterial pressure (Ppa) waveform.
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Media file 9: Pulmonary arterial pressure (Ppa) waveform.
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Pulmonary arterial pressure (Ppa) waveform.

Pulmonary arterial pressure (Ppa) waveform.

Pulmonary artery wedge pressure (PAWP) waveform c...
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Media file 10: Pulmonary artery wedge pressure (PAWP) waveform can be distinguished easily from the pulmonary arterial waveform in most clinical scenarios.
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Pulmonary artery wedge pressure (PAWP) waveform c...

Pulmonary artery wedge pressure (PAWP) waveform can be distinguished easily from the pulmonary arterial waveform in most clinical scenarios.

Pulmonary artery wedge pressure (PAWP) reflects l...
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Media file 11: Pulmonary artery wedge pressure (PAWP) reflects left atrial pressure (LAP).
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Pulmonary artery wedge pressure (PAWP) reflects l...

Pulmonary artery wedge pressure (PAWP) reflects left atrial pressure (LAP).

Inflated balloon obstructs arterial flow and refl...
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Media file 12: Inflated balloon obstructs arterial flow and reflects pressures at J point. Redrawn from Principles of Critical Care by Jesse B. Hall, Gregory A. Schmidt, Lawrence D. H. Wood, 2000, McGraw-Hill, Inc.
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Inflated balloon obstructs arterial flow and refl...

Inflated balloon obstructs arterial flow and reflects pressures at J point. Redrawn from Principles of Critical Care by Jesse B. Hall, Gregory A. Schmidt, Lawrence D. H. Wood, 2000, McGraw-Hill, Inc.

Having an inflated balloon in a proximal vessel i...
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Media file 13: Having an inflated balloon in a proximal vessel is better because a vessel branch is likely to reflect left atrial pressure (LAP) accurately. Redrawn from Principles of Critical Care by Jesse B. Hall, Gregory A. Schmidt, Lawrence D. H. Wood, 2000, McGraw-Hill, Inc.
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Having an inflated balloon in a proximal vessel i...

Having an inflated balloon in a proximal vessel is better because a vessel branch is likely to reflect left atrial pressure (LAP) accurately. Redrawn from Principles of Critical Care by Jesse B. Hall, Gregory A. Schmidt, Lawrence D. H. Wood, 2000, McGraw-Hill, Inc.

Right or left atrial pressure waveform.
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Media file 14: Right or left atrial pressure waveform.
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Right or left atrial pressure waveform.

Right or left atrial pressure waveform.

Timing of the pulmonary artery waveforms in relat...
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Media file 15: Timing of the pulmonary artery waveforms in relation to electrocardiographic monitoring is shown here. An A wave follows the QRS wave on ECG, whereas V wave follows the T wave on ECG.
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Timing of the pulmonary artery waveforms in relat...

Timing of the pulmonary artery waveforms in relation to electrocardiographic monitoring is shown here. An A wave follows the QRS wave on ECG, whereas V wave follows the T wave on ECG.

Physiologic lung zones. For pulmonary capillary w...
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Media file 16: Physiologic lung zones. For pulmonary capillary wedge pressure (PCWP) to be reliable, the catheter tip must lie in zone 3. Pulmonary artery pressure (Ppa) is greater than pulmonary venous pressure (Ppv), which is greater than alveolar pressure (Palv) at end-expiration. In zones 1 and 2, Ppw reflects Palv if Palv is greater than Ppv. Redrawn from Principles of Critical Care by Jesse B. Hall, Gregory A. Schmidt, Lawrence D. H. Wood, 2000, McGraw-Hill, Inc.
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Physiologic lung zones. For pulmonary capillary w...

Physiologic lung zones. For pulmonary capillary wedge pressure (PCWP) to be reliable, the catheter tip must lie in zone 3. Pulmonary artery pressure (Ppa) is greater than pulmonary venous pressure (Ppv), which is greater than alveolar pressure (Palv) at end-expiration. In zones 1 and 2, Ppw reflects Palv if Palv is greater than Ppv. Redrawn from Principles of Critical Care by Jesse B. Hall, Gregory A. Schmidt, Lawrence D. H. Wood, 2000, McGraw-Hill, Inc.

Hemodynamic parameters in different pathologic st...
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Media file 17: Hemodynamic parameters in different pathologic states.
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Hemodynamic parameters in different pathologic st...

Hemodynamic parameters in different pathologic states.

Tall V waves presented here on pulmonary arterial...
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Media file 18: Tall V waves presented here on pulmonary arterial and wedge pressure waveforms are characteristic of severe mitral regurgitation.
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Tall V waves presented here on pulmonary arterial...

Tall V waves presented here on pulmonary arterial and wedge pressure waveforms are characteristic of severe mitral regurgitation.

Large V waves in a case of mitral regurgitation.
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Media file 19: Large V waves in a case of mitral regurgitation.
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Large V waves in a case of mitral regurgitation.

Large V waves in a case of mitral regurgitation.

Simultaneous recording of ECG helps identify V wa...
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Media file 20: Simultaneous recording of ECG helps identify V waves in mitral vale regurgitation; V waves correspond to T waves on ECG.
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Simultaneous recording of ECG helps identify V wa...

Simultaneous recording of ECG helps identify V waves in mitral vale regurgitation; V waves correspond to T waves on ECG.

Hemodynamic monitoring can confirm the diagnosis ...
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Media file 21: Hemodynamic monitoring can confirm the diagnosis of pericardial tamponade. Equalization of diastolic pressures on the left and right sides of the heart, elevated right atrial pressure, and Kussmaul sign (ie, increase in right atrial pressure with inspiration) are noted.
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Hemodynamic monitoring can confirm the diagnosis ...

Hemodynamic monitoring can confirm the diagnosis of pericardial tamponade. Equalization of diastolic pressures on the left and right sides of the heart, elevated right atrial pressure, and Kussmaul sign (ie, increase in right atrial pressure with inspiration) are noted.

In cardiac tamponade, systemic arterial pressure ...
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Media file 22: In cardiac tamponade, systemic arterial pressure (Pa) reflects pulsus paradoxus. Right atrial pressure (RAP) is elevated. Pulmonary artery (PA) diastolic pressure equals mean right atrial (RA), right ventricular (RV) diastolic, and wedge pressures.
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In cardiac tamponade, systemic arterial pressure ...

In cardiac tamponade, systemic arterial pressure (Pa) reflects pulsus paradoxus. Right atrial pressure (RAP) is elevated. Pulmonary artery (PA) diastolic pressure equals mean right atrial (RA), right ventricular (RV) diastolic, and wedge pressures.

Simultaneous recordings of pulmonary capillary we...
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Media file 23: Simultaneous recordings of pulmonary capillary wedge pressure and left ventricular pressure waveforms in a patient with constrictive pericarditis. Note the equalization of diastolic pressures and "square root sign" or "dip and plateau sign" of the left ventricular waveforms, which are confirmatory of the diagnosis of constrictive pericarditis.
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Simultaneous recordings of pulmonary capillary we...

Simultaneous recordings of pulmonary capillary wedge pressure and left ventricular pressure waveforms in a patient with constrictive pericarditis. Note the equalization of diastolic pressures and "square root sign" or "dip and plateau sign" of the left ventricular waveforms, which are confirmatory of the diagnosis of constrictive pericarditis.

Right atrial pressure waveform of a patient with ...
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Media file 24: Right atrial pressure waveform of a patient with constrictive pericarditis. Please note rapid X and Y descents, and elevated A and V waves. This gives an impression of the letter "M" or "W" and is confirmatory of the diagnosis of constrictive pericarditis.
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Right atrial pressure waveform of a patient with ...

Right atrial pressure waveform of a patient with constrictive pericarditis. Please note rapid X and Y descents, and elevated A and V waves. This gives an impression of the letter "M" or "W" and is confirmatory of the diagnosis of constrictive pericarditis.

Principle of cardiac output measurement.
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Media file 25: Principle of cardiac output measurement.
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Principle of cardiac output measurement.

Principle of cardiac output measurement.

More on Pulmonary Artery Catheterization

References
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References

  1. [Guideline] Mueller HS, Chatterjee K, Davis KB. ACC expert consensus document. Present use of bedside right heart catheterization in patients with cardiac disease. American College of Cardiology. J Am Coll Cardiol. Sep 1998;32(3):840-64. [Medline].

  2. WEST JB, DOLLERY CT, NAIMARK A. DISTRIBUTION OF BLOOD FLOW IN ISOLATED LUNG; RELATION TO VASCULAR AND ALVEOLAR PRESSURES. J Appl Physiol. Jul 1964;19:713-24. [Medline].

  3. Corcoran TB, Grape S, Duff O, Perry PL, Murray R. The pulmonary artery catheter sleeve--protective or infective?. Anaesth Intensive Care. Mar 2009;37(2):290-5. [Medline].

  4. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. Jan 2 2003;348(1):5-14. [Medline].

  5. Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA. Nov 26 2003;290(20):2713-20. [Medline].

  6. Rhodes A, Cusack RJ, Newman PJ. A randomised, controlled trial of the pulmonary artery catheter in critically ill patients. Intensive Care Med. Mar 2002;28(3):256-64. [Medline].

  7. [Best Evidence] Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet. Aug 6-12 2005;366(9484):472-7. [Medline].

  8. Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. Oct 5 2005;294(13):1625-33. [Medline].

  9. Shah MR, Hasselblad V, Stevenson LW, Binanay C, O'Connor CM, Sopko G. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA. Oct 5 2005;294(13):1664-70. [Medline].

  10. [Best Evidence] The National Heart, Lung and Blood Institute Acute Respiratory Distress Syndrome Clinical Trial Network, Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. May 25 2006;354(21):2213-24. [Medline].

  11. Djaiani G, Karski J, Yudin M, Hynninen M, Fedorko L, Carroll J. Clinical outcomes in patients undergoing elective coronary artery bypass graft surgery with and without utilization of pulmonary artery catheter-generated data. J Cardiothorac Vasc Anesth. Jun 2006;20(3):307-10. [Medline].

  12. [Best Evidence] S Harvey et al. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database of Systematic Reviews. july 19, 2006;3:[Medline]. [Full Text].

  13. Chittock DR, Dhingra VK, Ronco JJ, Russell JA, Forrest DM, Tweeddale M. Severity of illness and risk of death associated with pulmonary artery catheter use. Crit Care Med. Apr 2004;32(4):911-5. [Medline].

  14. Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993-2004. JAMA. Jul 25 2007;298(4):423-9. [Medline]. [Full Text].

  15. van Lelyveld-Haas LE, van Zanten AR, Borm GF, Tjan DH. Clinical validation of the non-invasive cardiac output monitor USCOM-1A in critically ill patients. Eur J Anaesthesiol. Nov 2008;25(11):917-24. [Medline].

  16. Chatterjee K. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation. Jan 6 2009;119(1):147-52. [Medline].

  17. Greenberg SB, Murphy GS, Vender JS. Current use of the pulmonary artery catheter. Curr Opin Crit Care. Jun 2009;15(3):249-53. [Medline].

  18. Vincent JL, Pinsky MR, Sprung CL, Levy M, Marini JJ, Payen D, et al. The pulmonary artery catheter: in medio virtus. Crit Care Med. Nov 2008;36(11):3093-6. [Medline].

  19. Bayliss J, Norell M, Ryan A. Bedside haemodynamic monitoring: experience in a general hospital. Br Med J (Clin Res Ed). Jul 16 1983;287(6386):187-90. [Medline].

  20. Bernard GR, Sopko G, Cerra F. Pulmonary artery catheterization and clinical outcomes: National Heart, Lung, and Blood Institute and Food and Drug Administration Workshop Report. Consensus Statement. JAMA. May 17 2000;283(19):2568-72. [Medline].

  21. Connors AF Jr, McCaffree DR, Gray BA. Evaluation of right-heart catheterization in the critically ill patient without acute myocardial infarction. N Engl J Med. Feb 3 1983;308(5):263-7. [Medline].

  22. Connors AF Jr, Speroff T, Dawson NV. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. Sep 18 1996;276(11):889-97. [Medline].

  23. Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med. Jul 1984;12(7):549-53. [Medline].

  24. Fein AM, Goldberg SK, Walkenstein MD. Is pulmonary artery catheterization necessary for the diagnosis of pulmonary edema?. Am Rev Respir Dis. Jun 1984;129(6):1006-9. [Medline].

  25. Hoar PF, Wilson RM, Mangano DT. Heparin bonding reduces thrombogenicity of pulmonary-artery catheters. N Engl J Med. Oct 22 1981;305(17):993-5. [Medline].

  26. Iberti TJ, Fischer EP, Leibowitz AB, Panacek EA, Silverstein JH, Albertson TE. A multicenter study of physicians' knowledge of the pulmonary artery catheter. Pulmonary Artery Catheter Study Group. JAMA. Dec 12 1990;264(22):2928-32. [Medline].

  27. Kearney TJ, Shabot MM. Pulmonary artery rupture associated with the Swan-Ganz catheter. Chest. Nov 1995;108(5):1349-52. [Medline].

  28. Matthay MA, Chatterjee K. Bedside catheterization of the pulmonary artery: risks compared with benefits. Ann Intern Med. Nov 15 1988;109(10):826-34. [Medline].

  29. Mermel LA, Maki DG. Infectious complications of Swan-Ganz pulmonary artery catheters. Pathogenesis, epidemiology, prevention, and management [published erratum appears in Am J Respir Crit Care Med 1994 Jul;150(1):290]. Am J Respir Crit Care Med. Apr 1994;149(4 Pt 1):1020-36. [Medline].

  30. Pinsky MR, Vincent JL. Let us use the pulmonary artery catheter correctly and only when we need it. Crit Care Med. May 2005;33(5):1119-22. [Medline].

  31. Pulmonary Artery Catheter Consensus conference: consensus statement. Crit Care Med. Jun 1997;25(6):910-25. [Medline].

  32. Swan HJ. The pulmonary artery catheter. Dis Mon. Aug 1991;37(8):473-543. [Medline].

  33. Swan HJ, Ganz W, Forrester J. Catheterization of the heart in man with use of a flow-directed balloon- tipped catheter. N Engl J Med. Aug 27 1970;283(9):447-51. [Medline].

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Further Reading

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Keywords

Swan-Ganz catheterization, pulmonary artery catheterization, right heart catheterization, hemodynamic monitoring, acute myocardial infarction, flow-directed balloon-tipped pulmonary artery catheter, primary pulmonary hypertension, valvular disease, cardiac tamponade

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Contributor Information and Disclosures

Author

Bojan Paunovic, MD, Assistant Professor, Department of Internal Medicine, Section of Critical Care, University of Manitoba; Medical Director of Critical Care, Grace Hospital, Canada
Bojan Paunovic, MD is a member of the following medical societies: Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Gregory J Dehmer, MD, Director, Division of Cardiology, Scott & White Healthcare; Professor of Medicine, Texas A&M Health Science Center College of Medicine
Gregory J Dehmer, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, Society for Cardiac Angiography and Interventions, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald J Oudiz, MD, FACP, FACC, Associate Professor of Medicine, Division of Cardiology, The David Geffen School of Medicine at UCLA; Director, Liu Center for Pulmonary Hypertension, LA Biomedical Research Institute at Harbor-UCLA Medical Center
Ronald J Oudiz, MD, FACP, FACC is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society
Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx  Clinical Trials + honoraria

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Karlheinz Peter, MD, PhD, Professor of Medicine, Monash University; Head of Centre of Thrombosis and Myocardial Infarction, Head of Division of Atherothrombosis and Vascular Biology, Associate Director, Baker Heart Research Institute; Interventional Cardiologist, The Alfred Hospital, Australia
Karlheinz Peter, MD, PhD is a member of the following medical societies: American Heart Association, Cardiac Society of Australia and New Zealand, and German Cardiac Society
Disclosure: Nothing to disclose.

 
 
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