Acute And Advanced Hf Clinical Presentation and Diagnosis of AHF

Patients with AHF present with symptoms of worsening fluid retention or decreasing exercise tolerance and fatigue (typically worsening of symptoms presented in the chronic HF clinical presentation text box). These symptoms reflect congestion behind the failing ventricle and/or hypoperfusion. Patients can be categorized into hemodynamic subsets based on assessment of physical signs and symptoms of congestion and/ 47

or hypoperfusion. Patients can be described as "wet" or "dry" depending on volume status, as well as "warm" or "cool" based on adequacy of tissue perfusion. "Wet" refers to patients with volume/fluid overload (e.g., edema and jugular venous distention [JVD]), whereas "dry" refers to euvolemic patients. "Warm" refers to patients with adequate CO to perfuse peripheral tissues (and hence the skin will be warm to touch), whereas "cool" refers to patients with evidence of hypoperfusion (skin cool to touch with diminished pulses). Additionally, invasive hemodynamic monitoring can be used to provide objective data for assessing volume status (pulmonary capillary wedge pressure [PCWP]) and perfusion (CO). A CI below 2.2 L/min/m is consistent with hypoperfusion and reduced contractility, and a PCWP above 18 mm Hg correlates with congestion and an elevated preload. The four possible hemodynamic subsets a patient may fall into are "warm and dry," "warm and wet," "cool and dry," or "cool and wet."

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