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Wet-Cold Haemodynamic Profile — EECC MCQ

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ModerateHeart FailureWet-Cold Haemodynamic ProfileEECC

A 70-year-old man with HFrEF is admitted with pulmonary oedema. He is treated with IV furosemide and NIV. His BP is 85/55 mmHg and he develops cold extremities, oliguria, and confusion. Lactate is 4.5 mmol/L. What haemodynamic profile does this represent?

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Correct answer: C — Wet-cold profile (congested + hypoperfused = cardiogenic shock) — the most dangerous haemodynamic phenotype requiring inotropic support and/or mechanical circulatory support in addition to decongestive therapy

The ESC HF Guidelines use a 2x2 haemodynamic classification: (1) Warm-dry (profile A): well-perfused, not congested — optimal; (2) Warm-wet (profile B): well-perfused, congested — treat with diuretics/vasodilators; (3) Cold-wet (profile C): hypoperfused AND congested — most dangerous, requires inotropes/vasopressors and diuretics; (4) Cold-dry (profile L): hypoperfused, not congested — needs cautious fluid challenge. This patient (pulmonary oedema + hypotension + cold extremities + elevated lactate) has wet-cold (profile C) = cardiogenic shock. Management: (1) dobutamine or milrinone for inotropy; (2) vasopressors (noradrenaline) if SBP <80 mmHg; (3) consider MCS (IABP, Impella, VA-ECMO); (4) cautious diuresis once perfusion improves. Vasodilators and excessive diuresis are contraindicated in the cold-wet state.

Reference: ESC (2023): HF Guidelines