Haemodynamic monitoring in acute heart failure

Acute Heart Failure is a major cause of hospitalisation, with a rate of death and complications. New guidelines have been developed in order to diagnose and treat this disease. Despite these efforts pathophysiology and treatments options are still limited. There is agreement among the experts that increasing the cardiac output and the stroke volume without fluid overloading the patient should be the goal of every treatment. Despite this, there is no agreement on how to monitor the cardiac function and how to follow it after a therapeutic intervention. In other fields of critical care cardiovascular monitoring and application of early goal directed protocols showed benefits. This review explores the available possibilities of how to monitor the cardiac function in Acute Heart Failure. Standard and more advanced techniques are presented. Cardiac output monitors from the pulmonary artery catheter to the pulse pressure analysis and Doppler techniques are discussed, with focus on this specific clinical setting. Undoubtedly monitoring is valuable tool, but without a protocol of how to manipulate the haemodynamics, no monitor will prove alone to be beneficial. Haemodynamic driven early goal directed therapy are largely awaited in this field of medicine.