Invasive hemodynamic monitoring

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Congestive Heart Failure Microchapters


Patient Information


Historical Perspective



Systolic Dysfunction
Diastolic Dysfunction


Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings


Chest X Ray

Cardiac MRI


Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies


Invasive Hemodynamic Monitoring

Medical Therapy:

Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Positive Inotropics
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Invasive hemodynamic monitoring On the Web

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Ongoing Trials at Clinical

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FDA on Invasive hemodynamic monitoring

CDC on Invasive hemodynamic monitoring

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Directions to Hospitals Treating Invasive hemodynamic monitoring

Risk calculators and risk factors for Invasive hemodynamic monitoring

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]


Based upon the results of the ESCAPE trial, there is no benefit in clinical outcomes associated with the routine use of a pulmonary artery line in patients with decompensated CHF.[1]

Invasive Monitoring

Supportive Trial Data

The ESCAPE trial (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness), was the first large, multicenter, randomized controlled trial that enrolled 433 patients across 26 sites, to determine the safety of pulmonary artery catheter (PAC) or Swan-Ganz catheter use to improve clinical outcomes in patients hospitalized with severe symptomatic and recurrent heart failure. Off the total 433 patients enrolled, 218 patients were randomized to clinical assessment alone (clinical arm) and the remaining 215 were randomized to both PAC and clinical assessment (PAC arm); with almost all patients being treated with loop diuretics (98%), ACE inhibitors (79%), beta-blockers (62%), and spironolactone (51%) and only a small percentage received inotropes (15%) and intravenous vasodilators (8%) at the time of randomization. At 6-month follow up, the primary endpoint achieved was identical and non-significant among both the arms with an overall mortality of 19%. Thus, the study concluded no benefit demonstrated with the use of PAC for the improvement of clinical outcomes in patients with advanced heart failure.[1]

2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) [2]

Invasive Hemodynamic Monitoring in Patients Presenting With Heart Failure (DO NOT EDIT) [2]

Class I
"1. Invasive hemodynamic monitoring should be performed to guide therapy in patients who are in respiratory distress or with clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment. (Level of Evidence: C) "
Class III (No Benefit)
"1. Routine use of invasive hemodynamic monitoring in normotensive patients with acute decompensated HF and congestion with symptomatic response to diuretics and vasodilators is not recommended. [1] (Level of Evidence: B) "
Class IIa
"1. Invasive hemodynamic monitoring can be useful for carefully selected patients with acute heart failure who have persistent symptoms despite empiric adjustment of standard therapies, and (Level of Evidence: C)
"a. Whose fluid status, perfusion, or systemic or pulmonary vascular resistances are uncertain,"
"b. Whose systolic pressure remains low, or is associated with symptoms, despite initial therapy,"
"c. Whose renal function is worsening with therapy,"
"d. Who require parenteral vasoactive agents or"
"e. Who may need consideration for advanced device therapy or transplantation. "

Vote on and Suggest Revisions to the Current Guidelines

External Links


  1. 1.0 1.1 1.2 Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW (2005). "Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial". JAMA : the Journal of the American Medical Association. 294 (13): 1625–33. doi:10.1001/jama.294.13.1625. PMID 16204662. Retrieved 2012-04-09. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 2.2 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  3. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 112 (12):e154-235. DOI:10.1161/CIRCULATIONAHA.105.167586 PMID: 16160202

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