New Modalities in Diagnosis and Management of Acute Heart Failure

Abstract

Background: Acute heart failure is classically defined by symptoms and signs related to elevated ventricular filling pressures. Regardless of precipitant, underlying etiology or ejection fraction, the vast majority of hospital admissions are the result of worsening chronic heart failure. For the acutely decompensated patient, 4 hemodynamic profiles ; stratified by degree of decongestion ("dry" or "wet") and adequacy of perfusion ("warm" or "cold") predict prognosis and guide therapy. Aims: The aim of this essay is to discuss the new modalities in diagnosis and management of acute heart failure. Methodology: The ability to accurately measure cardiac output remains an integral part of diagnosing and managing critically ill patients. There are many minimally invasive devices currently available on the market designed to reduce the risks associated with the use of PAC. These devices have variable degrees of ‘invasiveness’ with some being only marginally less invasive than PACs. Conclusion: VA ECMO is a potential therapy for patients with refractory cardiogenic shock, particularly in those with severe cardiogenic shock and combined respiratory failure. VA ECMO for cardiogenic shock is a bridge to recovery, durable VAD implantation, or transplantation, and clinical trajectory and prognosis must enter centrally into the judgment of a patient’s candidacy for ECMO. The use of VA ECMO in critically ill patients requires a multi- specialty team of practitioners.