Heart failure: Wet and cold, hypotensive

Presentation of Heart failure
Wet and cold

Wet

• Systemic venous congestion
• Orthopnea
• Paroxysmal nocturnal dyspnoea
• Breathlessness
• Bi-basilar rales
• An abnormal blood pressure response to the Valsalva maneuver (left-sided)
• Symptoms of gut congestion
• Jugular venous distension
• Hepatojugular reflux
• Hepatomegaly
• Ascites
• Peripheral oedema (right-sided)
• Wet mucous membranes
• Inferior vena cava does not appear collapsed on imaging
• Improves with diuresis

Cold

• Poor cardiac output
• Inadequate peripheral perfusion
• Cold skin

 

Hypotensive

• Systolic blood pressure below 90 mmHg

 

Management

In critical care areas

• Arterial cannulation
• Direct measurement of mean arterial pressure
• Inotropic therapy
• Vasopressor therapy
• Mechanical circulatory support

If blood pressure climbs above 90 mmHg

• Follow algorithm here

 

References

1. Piotr Ponikowski, Adriaan A Voors, Stefan D Anker, Héctor Bueno, John G F Cleland, Andrew J S Coats, Volkmar Falk, José Ramón González-Juanatey, Veli-Pekka Harjola, Ewa A Jankowska, Mariell Jessup, Cecilia Linde, Petros Nihoyannopoulos, John T Parissis, Burkert Pieske, Jillian P Riley, Giuseppe M C Rosano, Luis M Ruilope, Frank Ruschitzka, Frans H Rutten, Peter van der Meer, ESC Scientific Document Group, 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)
   Developed with the special contribution of the Heart Failure Association (HFA) of the ESC, European Heart Journal, Volume 37, Issue 27, 14 July 2016, Pages 2129–2200, https://doi.org/10.1093/eurheartj/ehw128