The Rational Clinical Examination
David L. Simel, Drummond Rennie
Abnormal Central Venous Pressure
David L. Simel, Deborah Cook
Make the Diagnosis: Abnormal Central Venous Pressure
Topics Discussed:
central venous pressure, measurement of, central venous pressure-biological function, criterion standard comparisons (diagnostic tests), left ventricular ejection fraction, likelihood ratio, make the diagnosis, prior probability
Excerpt:
"Estimating the prior probability for an elevated CVP among patients
with a low ejection fraction depends on the patient's underlying
condition and the effectiveness of treatment. Current treatment
regimens that now include 
-blockers and angiotensin-converting
enzyme inhibitors may decrease the prevalence of volume overload
low in patients with a reduced ejection fraction. In the Studies
of Left Ventricular Dysfunction, investigators determined
clinically that approximately 10% of patients with a left
ventricular ejection fraction 35% or less at baseline had
an elevated CVP.3,4 Although the CVP was not invasively
measured, we know that clinical assessments of a high CVP typically
underestimated the true value. As a starting point, the range 10% to
20% seems like a reasonable estimate for elevated CVP among
patients previously diagnosed as having a low ejection fraction...."
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