Markers of severity

Bedside diagnosis of left ventricular failure is based on history, symptoms, and clinical signs. Right heart failure may present without chest signs but with evidence of poor organ perfusion and, over time, venous congestion (e.g. peripheral edema, hepatomegaly).

A greater degree of heart failure is suggested by progressive dyspnea, obtundation, hypotension, oliguria, and cyanosis. Biochemical markers of severity include a metabolic acidosis with associated hyperlactatemia. A low stroke volume and mixed venous oxygen saturation below 60 per cent are additional indicators of poor cardiac performance and inability to meet tissue oxygen demands. Pulmonary artery wedge pressures and central venous pressures are not necessarily elevated.

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