ICU Vivas · Acute heart failure
Data viva — the haemodynamic profile in acute heart failure
A data viva on recognising the wet-cold profile and cardiogenic shock, vasopressor and inotrope choice, the mechanical circulatory support trials, and starting sacubitril-valsartan after stabilisation.
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CICMFFICMEDIC
Prompt
Bedside and laboratory data from a patient with acute heart failure, to be classified and managed.
Stimulus
You are shown the data of a patient admitted with acute heart failure:
| Variable | Value |
|---|---|
| Blood pressure | 84/58 mmHg |
| Heart rate | 108 (sinus) |
| JVP | Raised, bilateral crackles |
| Peripheries | Cold and sweaty |
| Mental state | Confused |
| Urine output | 0.3 mL/kg/h |
| Lactate | 4.1 mmol/L |
| EF (echo) | 20 per cent |
Classify and manage.[2]
References8ShowHide
- [1]McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European heart journal, 2021.PMID 34447992
- [2]Nohria A, Tsang SW, Fang JC, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure J Am Coll Cardiol, 2003.PMID 12767667
- [3]De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock N Engl J Med, 2010.PMID 20200382
- [4]Cuffe MS, Califf RM, Adams K F Jr, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial JAMA, 2002.PMID 11911756
- [5]Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock N Engl J Med, 2012.PMID 22920912
- [6]Thiele H, Zeymer U, Akin I, et al. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. The New England journal of medicine, 2023.PMID 37634145
- [7]Møller JE, Engstrøm T, Jensen LO, et al. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. The New England journal of medicine, 2024.PMID 38587239
- [8]Velazquez EJ, Morrow DA, DeVore AD, et al. Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure (PIONEER-HF). New England Journal of Medicine, 2019.PMID 30415601