6/14/2017 1 Pulsatility is overrated: Acute Decompensated Heart Failure in the ICU Carolina Dimsdale DNP, ACNP-BC, AACC No Disclosures I have no current affiliation or financial arrangement with any grantor or commercial interests that might have direct interest in the subject matter of this CE Program.
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6/14/2017
1
Pulsatility is overrated: Acute Decompensated
Heart Failure in the ICU
Carolina Dimsdale DNP, ACNP-BC, AACC
No Disclosures
I have no current affiliation or financial
arrangement with any grantor or commercial interests that might have direct interest in the
subject matter of this CE Program.
6/14/2017
2
Objectives
1. Discuss clinical manifestations of acutely
decompensated heart failure.2. Describe management strategies including
medical and surgical options for therapy.
3. Review modern indications and usage of mechanical circulatory support.
What’s Acute Heart Failure?
• Ejection Fraction
• Symptoms
• End Organ Functiono Liver function
o Kidney function
o Neurologic status
Low Cardiac Output
Hypotension
Oliguria
Classifications• Framingham Heart Study classification
• ACC AHA
• Forrester
• Killip
• NYHA Yancy et al, 2013
6/14/2017
3
Acute Heart Failure
Case Study• 59F with PMH of ICM, VT s/p ICD placement. EF known to be
35%, mild AI, moderate TR.
• Admitted to ED complaining of lethargy, swelling, nausea x 1 week. Says she has been compliant with her diuretic regime, no dietary indiscretions
• Today’s echo: EF 20%, severe RV dysfunction, severe TR
• Objectively: dyspneic, nauseous, significant JVD, extremetiesare cool but dry
She is admitted to the Cardiac ICU for medical management.