Se define como insuficiencia crónica avanzada (IC) al cuadro clínico caracterizado por la persistencia de síntomas en clase funcional III-IV a pesar del tratamiento con diuréticos, inhibidores de la enzima convertidora de la angiotensina (IECA) y digital, en un paciente con severo deterioro de la función ventricular. Esta definición implica un mal pronóstico, con un riesgo de muerte anual de aproximadamente 35%.
Presentación Clínica
Los pacientes con insuficiencia cardíaca avanzada se pueden dividir en dos grupos:
a) Pacientes con síntomas y signos congestivos pero con buena tensión arterial y buena perfusión periférica.
b) Pacientes con hipotensión arterial sintomática y/o inadecuada perfusión con o sin manifestaciones de congestión.
En los pacientes con adecuada perfusión puede ajustarse el tratamiento médico de acuerdo a los parámetros clínicos, y su manejo habitualmente es posible en forma ambulatoria. Cuando la respuesta terapéutica no sea satisfactoria en este subgrupo, así como en los pacientes hipotensos sintomáticos o hipoperfundidos, es necesaria la internación para efectuar el tratamiento por vía parenteral.
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