Subset IV Cool and

• CI less than 2.2 L/min/m2, PCWP greater than 18 mm Hg

• Patients are inadequately perfused and congested

• Classified as the most complicated clinical presentation of AHF with the worst prognosis

• Most challenging to treat; therapy targets alleviating signs and symptoms of congestion by increasing CI as well as reducing PCWP, while maintaining adequate mean arterial pressure

• Treatment involves a delicate balance among diuretics, vasodilators, and inotropic agents

• Use of vasopressors is sometimes necessary to maintain BP

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