Fluid Overload Assessment and Management in Heart Failure Patients

Heart failure is a syndrome in which myocardial function is incapable of providing for normal physiologic needs. In the acute care setting, cardiac dysfunction primarily manifests with volume perturbations and presents with signs and symptoms of vascular congestion. Thus, in acute heart failure volume assessment is crucial in diagnosing and improving the prognosis. Also, goal-directed therapy relies on accurate volume assessment to minimize the adverse outcomes of inappropriate, ineffective, or excessive diuresis. Currently, in most institutions clinical methods of volume assessment are the mainstay. However, these methods are highly dependent on the practitioners' skill level. In fact, there is a high variability between experienced physicians when assessing volume. As adjuncts, objective methods of volume assessment are being developed and used such as natriuretic peptides, bioimpedance analysis, and imaging. Semin Nephrol 32:112-120 (C) 2012 Elsevier Inc. All rights reserved.