Low cardiac output syndrome

Evaluate and optimize chronic therapy D/C meds that worsen HF Assess for signs/symptoms of fluid overload and/or low cardiac output syndrome... 

If there is dear evidence of worsening prompt hospital admission for intensive therapy is necessary. As the availability of a suitable donor heart is not predictable, hemodynamic deterioration is first treated with intravenous inotropic support. When the low-cardiac-output syndrome continues to be refractory, patients are put on a mechanical circulatory device for temporary mechanical support. This bridge to transplantation concept enables patient stabilization, withdrawal of intravenous medication (inotropic agents, catecholamines, calcium sensitizers) and rehabilitation (Antretter et al. 2002a). During chronic mechanical circulatory support a low level of exercise is possible and the patients are able to walk around, to leave hospital and sometimes they are followed up by heart failure specialists in an outpatient clinic. Nearly 25% of the most recent cohort transplanted from 1 January, 2001 to 30 June, 2003 were on some type of mechanical circulatory support (Taylor et al. 2004). 

Treatment with prednisone or dexa-methasone has been reported to induce hypertension of the vasoconstrictor type (S3 ). In an uncontrolled study, administration of methylprednisolone (30 mg/kg) in patients undergoing cardiac surgery resulted in a higher incidence of low cardiac output syndrome and increased need for post-operative mechanical ventilation. It should be mentioned that the steroid-treated patients... 

Propofol infusion syndrome is a syndrome of cardiac failure (bradycardia, hypotension, low cardiac output), metabolic acidosis, and rhabdomyolysis, first described in children receiving high-dose propofol infusions for more than 48 hours. 

Schrier RW Pathogenesis of sodium and water retention in high-output and low- output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy (2). N.Engl.J.Med. 319 1127-1134,1988... 

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