In acute decompensated heart failure, which of the following is true about hemodynamics?

• A. Decreased stroke volume, decreased cardiac output, increased filling pressures, increased systemic vascular resistance
• B. Increased stroke volume with decreased filling pressures
• C. Normal stroke volume with decreased SVR
• D. Decreased CVP with decreased PCWP

Answer: (A)

In acute decompensated heart failure, the heart’s pumping ability is impaired, so forward flow drops, leading to a decreased stroke volume and thus lower cardiac output. Because the ventricle can’t eject effectively, pressures behind it rise, so filling pressures are elevated (reflected in higher CVP and PCWP). To try to maintain blood pressure in the face of reduced forward flow, the body activates neurohormonal systems that constrict vessels, increasing systemic vascular resistance. Put together, this pattern shows decreased stroke volume and cardiac output with increased filling pressures and increased systemic vascular resistance.