Acute Decompensated Heart Failure with Dr. Balint Laczay

Acute decompensated heart failure is reviewed by Cleveland Clinic cardiology fellow, Balint Laczay, MD. Learn and review clinical presentation, definitions classifications, etiologies, and treatment of heart failure in the hospital setting. This is part of our cardionerds cardiovascular fundamentals series.
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[@Mzw9rc]

Thank you, this helps a lot!

[@davidmbeckmann]

In the third patient, float a Swan and give fluid guided by the wedge?! Or give fluid in 250ml aliquots with serial evaluation of neck veins?!

[@julienmercier9281]

Very useful. Thanks for this video!

[@sanaullah6911]

Very useful overview. Precisely what criteria are used to decide the need for mechanical circulatory support?

[@cardionerds1503]

Great question. Lots of nuances there. We will be tackling this subject more in depth on a podcast in the future. Check out our heart failure series www.cardionerds.com/episodes/heart-failure-awareness-cardionerds-series/ for more information about advanced therapies in heart failure.

[@balintlaczay6816]

Great question, thanks for asking. It's a very difficult decision as noted previously. You need to factor in the patient and their comorbidities, the state of their heart, and the severity of what process they are going through. Patients who require MCS are usually failing medical therapy (ie, persistently hypotensive, low output, not clearing lactate, end organs are underperfused). Then you have to assess what the goal or endpoint is, whether it's as a bridge to recovery (such as a patient with a transient process you think will reverse) or a bridge to a definitive treatment, which could include a transplant, LVAD, high risk PCI, VT ablation, just as a few examples. You then need to assess the patient and their comorbidities to consider how they would fare on MCS and whether they would be a candidate for the definitive therapies above. It's a complex that decision that needs coordinated input from the primary team, intensitivist, and interventionalists/heart failure specialists and of course the patient/family themselves.

[@sanaullah6911]

@@balintlaczay6816 Thanks for your reply. I am not sure about adult data, but certainly in pediatrics there's good evidence to show that early use of MCS has better outcomes than waiting for organs to start failing.

[@balintlaczay6816]

@@sanaullah6911 Of course, thanks for clarifying. There are certainly differences in pediatrics and adults which I'm not the best one to clarify. And as for "waiting for organs to fail" what I meant to say is that end organ malperfusion is what often leads providers to pull the trigger on MCS. There are of course occasions where based on clinical trajectory or anticipated procedures MCS is pursued earlier in the clinical course.

[@LuckystudioLUQMANKHAN]

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[@طنطلطيفة]

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