The American journal of geriatric cardiology
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Am J Geriatr Cardiol · Sep 2005
ReviewAmbulatory hemodynamics in patients with chronic heart failure: implications for volume management in elderly patients.
Invasive hemodynamic assessment of patients with chronic heart failure is helpful in managing severe congestive symptoms associated with acute volume exacerbations that lead to hospitalizations. Information useful in guiding medication changes targeting control of left ventricular filling pressures can be obtained from measurements in the right ventricle. With the advent of implantable devices designed to treat heart failure, the logical next development is an implanted device that incorporates sophisticated monitoring systems capable of continuous acquisition of hemodynamic information over a long-term period. ⋯ This approach may be especially helpful for elderly patients with chronic heart failure in whom overdiuresis or volume contraction may lead to gait instability and falls. Additionally, elderly patients with heart failure from primary diastolic dysfunction may have a very narrow therapeutic window of optimal volume that is difficult to assess by daily weights and physical examination alone. This hypothesis is currently being tested in a prospective randomized clinical trial.