# Infiltrative Hemodynamics: Pressure Is Not Flow

Catheterization defines physiology, not amyloid type. Integrate monoclonal studies, tissue, and imaging when infiltrative disease remains suspected.

![Infographic: Infiltrative Hemodynamics: Pressure Is Not Flow](https://urinenephrology.org/visual-reference/images/mastery-amyloid-hemodynamics.png?v=20261003c)

## Restricted filling

Infiltrative myocardial disease can elevate filling pressures while limiting stroke volume. Congestion and poor forward flow can coexist despite a preserved ejection fraction.

## Ask what explains symptoms

Dyspnea, edema, exercise intolerance, hypotension, and kidney dysfunction may reflect different combinations of filling pressure and cardiac output.

## Check the measurement before the label

Verify transducer reference, waveform position, wedge quality, respiratory variation, and cardiac-output method. Interpret right atrial pressure, wedge pressure, and output together. Elevated pressure alone cannot distinguish adequate filling from a stiff chamber with poor forward flow.

## Separate pericardial from myocardial disease

Constrictive pericardial disease and restrictive cardiomyopathy can both show high filling pressures and dip-and-plateau waveforms. Respiratory ventricular interdependence, simultaneous pressure tracings, and pericardial imaging help separate them. Pressure equalization alone is insufficient to diagnose constriction.

## Use results to guide care

Hemodynamic findings can clarify congestion, low output, and treatment tolerance. Avoid reducing a complex circulation to one pressure cutoff.

## Connect back to diagnosis

Catheterization defines physiology, not amyloid type. Integrate monoclonal studies, tissue, and imaging when infiltrative disease remains suspected.

## Source lessons

- [rhc amyloid](https://urinenephrology.org/mastery/amyloid-series/rhc-amyloid.html)
- [amyloid hemodynamic patterns](https://urinenephrology.org/mastery/glomerular/amyloid-hemodynamic-patterns.html)
- [restrictive vs constrictive](https://urinenephrology.org/mastery/rhc/restrictive-vs-constrictive.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.