Medical management of decompensated heart failure in adult patients: Part 2: Organ involvement, invasive hemodynamic monitoring, device therapy, and outcomes

Acute decompensated heart failure is a clinical syndrome involving the congestion of vital organs, such as the kidneys, liver, and brain, leading to loss of autoregulation and multiorgan failure. The interaction between organ systems is bi-directional and complex; it cannot be explained by hypoperfusion alone. Despite the multiple signs and symptoms that arise with systemic congestion, there are limitations in the assessment of volume status based only on clinical evaluation. Invasive hemodynamic monitoring is an adjunctive diagnostic and prognostic tool in acute decompensated heart failure when standard therapy fails and/or leads to worsening renal function as well as for the evaluation of advanced therapy options. This review will discuss the use of temporary mechanical circulatory support devices in cardiogenic shock and the expected outcomes for advanced heart failure with the implementation of left ventricular assist devices and cardiac transplantation.