Supporting Cardiac Function

In order to obta in the best cardiac index and relieve pulmonary congestion, the team focuses therapy on three areas: preload, right-heart afterload, and left-heart afterload. Preload is reduced by balancing diuretics and vasodilators. The diuretics lower circulating blood volume. Vasodilators shift intravascular volume to the periphery. Right-heart afterload is lowered by reducing the inflow and improving the outflow. High pulmonary pressures threaten the lungs' ability to oxygenate properly and impair coronary vessel perfusion. Left-heart afterload reduction is achieved by artful titration of inotropes and vasodilators. Meanwhile, the body has reactions of its own, trying to maintain adequate perfusion of vital organs in the face of diminishing cardiac output.