[Verse 1] Catheter threading up the femoral line, wire finds the right heart, that's prime time, RV pressure stacked against PA, peak-to-peak gradient tells it straightaway. Systolic numbers duel like a courtroom fight, RV-to-systemic ratio shows who's losing the night, past two-thirds and the right side's straining, Fick or thermodilution, cardiac output's the framing, pulmonary vascular resistance, the quiet back pressure, Wood units whisper if the lungs can take the measure. [Chorus] Gradient, ratio, output, resistance, four numbers map the conduit's existence, squeeze the balloon, watch the artery shiver, five percent pinch, that's the coronary river, VO2 falling, slope climbing steep, NT-proBNP won't let the right heart sleep. [Verse 2] Before the new valve drops, the balloon takes the stage, high-pressure rehearsal, testing before the cage, root injection, dye painting the coronary tree, angiogram watching if the artery agrees, one in twenty candidates, compression's the catch, left main pinned flat, no transcatheter match, open surgery waits if that vessel goes dim, screen before you stent, never gamble on a whim. [Chorus] [Verse 3] Treadmill climbing, mask upon the face, peak VO2 percent predicted sets the pace, VE over VCO2, the slope that won't lie, steep incline whispers the lungs run dry, chronotropic response, heart rate climbing late, sluggish rise under load, a worrying trait, PVCs firing when the workload's steep, exercise arrhythmia's a trigger, not a shrug to keep, and a falling VO2, even symptom-free, the guideline says move now, don't wait to see. [Verse 4] Clip on the Holter, weeks on end it spies, non-sustained runs of VT in disguise, atrial flutter sneaking through the wire, rhythm strips reveal what the muscle requires, serial NT-proBNP, drawn again and again, a rising curve tracks the RV's silent strain, numbers stack together, a prognosis takes form, feeding the chapters where decisions are born. [Verse 5] Cardiac MRI maps the muscle's fate, fibrosis patterns tell us if we're too late, late gadolinium, scar tissue's trace, right ventricle volumes measured in place, ejection fraction slipping, function in decline, strain imaging catches what the eye can't define, layer the pictures on the hemodynamic chart, every modality adds a piece to the heart. [Bridge] Pressure, oxygen, rhythm, and hormone, four witnesses testify, the heart's not alone, cath lab, treadmill, monitor, and blood, read them together before the next cut. [Chorus] [Outro] Gradient, ratio, resistance, output flow, balloon and dye before the valve can go, VO2 drops, the slope runs steep, proBNP climbing, the RV can't sleep, write it all down, let the data decide, when the conduit's calling, don't let it hide.
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