Low Output Heart Failure: The Cold and Wet Patient

Abstract

While most patients admitted with congestive heart failure have preserved blood pressure and adequate organ perfusion, an important minority present with low cardiac output and profound organ dysfunction. A careful physical examination can help detect these patients who exhibit signs of volume overload (elevated neck veins, peripheral edema) and impaired cardiac output (narrow pulse pressure, cool or cold extremities). The cold wet patient has significantly increased mortality, even during the hospitalizations because of a cascade of physiologic abnormalities which must be recognized and reversed quickly to avoid multiorgan failure. Worsening renal function is often the first marker of critical illness in the cold wet patient and is one cause of the cardiorenal syndrome. Although low cardiac output may be the cause of a minority of cases of the cardiorenal syndrome, its contribution when present must be recognized and corrected, if possible, to prevent further renal deterioration and patient demise.