🫀 Acute MI Hemodynamic Subsets (Forrester)
Forrester classification subsets acute MI/heart failure hemodynamics by cardiac index and pulmonary capillary wedge pressure.
The bedside 'warm/cold · wet/dry' (Nohria-Stevenson) scheme approximates Forrester without a pulmonary artery catheter (original synthesis · not guideline verbatim).
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When to use
Use with invasive (or bedside-approximated) hemodynamics to place a patient in one of four subsets and direct therapy.
How it works
CI cutoff 2.2 and PCWP cutoff 18 define: I warm & dry, II warm & wet (diurese/vasodilate), III cold & dry (cautious fluids/inotrope), IV cold & wet (inotrope/pressor ± MCS).
Key points
- The bedside 'warm/cold · wet/dry' (Nohria-Stevenson) scheme approximates Forrester without a pulmonary artery catheter (original synthesis · not guideline verbatim).
- Original mortality figures predate modern reperfusion and overstate today's risk.
- Class III prompts a cautious fluid trial first, after excluding hypovolemia and RV infarction.
References
- Forrester JS, et al. Medical therapy of acute MI. N Engl J Med 1976.
- Nohria A, et al. Clinical assessment of hemodynamic profiles. JACC 2003.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Cardiac index CI | 2.0 L/min/m² |
|---|---|
| Pulmonary capillary wedge pressure PCWP | 22 mmHg |
→Forrester classClass IV
- Class：Class IV: Cold & wet (congestion + hypoperfusion, cardiogenic shock) (classic mortality ≈51%)
- Determination：CI 2 (cutoff 2.2) ↓ hypoperfusion; PCWP 22 (cutoff 18) ↑ congestion
- Management direction：Inotrope/pressor + diuresis/vasodilation (per BP) ± mechanical circulatory support; assess reperfusion
Frequently asked questions
- What is Acute MI Hemodynamic Subsets (Forrester)?
- Forrester classification subsets acute MI/heart failure hemodynamics by cardiac index and pulmonary capillary wedge pressure.
- How is Acute MI Hemodynamic Subsets (Forrester) calculated? What is the core formula?
- CI cutoff 2.2 and PCWP cutoff 18 define: I warm & dry, II warm & wet (diurese/vasodilate), III cold & dry (cautious fluids/inotrope), IV cold & wet (inotrope/pressor ± MCS).
- When is Acute MI Hemodynamic Subsets (Forrester) used?
- Use with invasive (or bedside-approximated) hemodynamics to place a patient in one of four subsets and direct therapy.
- What are the key clinical points for Acute MI Hemodynamic Subsets (Forrester)?
- The bedside 'warm/cold · wet/dry' (Nohria-Stevenson) scheme approximates Forrester without a pulmonary artery catheter (original synthesis · not guideline verbatim). Original mortality figures predate modern reperfusion and overstate today's risk. Class III prompts a cautious fluid trial first, after excluding hypovolemia and RV infarction.
- What are the limits and cautions when using Acute MI Hemodynamic Subsets (Forrester)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Acute MI Hemodynamic Subsets (Forrester) calculated in practice? Can you show a worked example?
- Inputs: Cardiac index CI 2.0 L/min/m², Pulmonary capillary wedge pressure PCWP 22 mmHg → Result: Forrester class Class IV（Class: Class IV: Cold & wet (congestion + hypoperfusion, cardiogenic shock) (classic mortality ≈51%), Determination: CI 2 (cutoff 2.2) ↓ hypoperfusion; PCWP 22 (cutoff 18) ↑ congestion, Management direction: Inotrope/pressor + diuresis/vasodilation (per BP) ± mechanical circulatory support; assess reperfusion）