36
Treatment
Water Restriction
Î Fluid restriction (1.5–2 L/d) is reasonable in stage D, especially in
patients with hyponatremia, to reduce congestive symptoms. (IIa-C)
Inotropic Support (see Tables 23 and 24)
Î Until definitive therapy (eg, coronary revascularization, MCS, heart
transplantation) or resolution of the acute precipitating problem,
patients with cardiogenic shock should receive temporary intravenous
inotropic support to maintain systemic perfusion and preserve end-
organ performance. (I-C)
Î Continuous intravenous inotropic support is reasonable as "bridge
therapy" in patients with stage D HF refractory to GDMT and
device therapy who are eligible for and awaiting MCS or cardiac
transplantation. (IIa-B)
Î Short-term, continuous intravenous inotropic support may be
reasonable in those hospitalized patients presenting with documented
severe systolic dysfunction who present with low blood pressure and
significantly depressed cardiac output to maintain systemic perfusion
and preserve end-organ performance. (IIb-B)
Î Long-term, continuous intravenous inotropic support may be
considered as palliative therapy for symptom control in select patients
with stage D HF despite optimal GDMT and device therapy who are not
eligible for either MCS or cardiac transplantation. (IIb-B)
Î Long-term use of either continuous or intermittent, intravenous
parenteral positive inotropic agents, in the absence of specific
indications or for reasons other than palliative care, is potentially
harmful in the patient with HF. (III-B: Harm)
Î Use of parenteral inotropic agents in hospitalized patients without
documented severe systolic dysfunction, low blood pressure, or
impaired perfusion, and evidence of significantly depressed cardiac
output, with or without congestion, is potentially harmful. (III-B: Harm)
