Hemodynamic profile of acute decompensated heart failure?

• A. Decreased SV, Decreased CI, Increased CVP, Increased PCWP and Increased SVR
• B. Increased SV, Increased CI, Decreased CVP, Decreased PCWP
• C. No change in SV or CI; variable SVR
• D. Decreased SVR; Decreased PCWP

Answer: (A)

In acute decompensated heart failure the heart can’t pump effectively, so forward flow drops. That means stroke volume falls, and with a reduced stroke volume you also see a lower cardiac index because overall output is diminished for the body’s needs. The failing ventricle can’t handle incoming blood, so pressures back up in the venous system and the heart’s upstream compartments rise. Central venous pressure goes up from venous congestion, and left-sided filling pressures rise as well, which shows up as an elevated pulmonary capillary wedge pressure. The body’s baroreceptor and renin-angiotensin system responses drive vasoconstriction to preserve pressure, so systemic vascular resistance increases.

So the pattern is decreased stroke volume and cardiac index with increased venous pressures (CVP) and left-sided filling pressures (PCWP) and increased SVR. The other patterns would imply either high forward flow or low afterload, which doesn’t fit the congestive, low-output state of acute decompensation.