🫀 Acute MI Hemodynamic Subsets (Forrester)
Forrester classification subsets acute MI/heart failure hemodynamics by cardiac index and pulmonary capillary wedge pressure.
Acute MI Hemodynamic Subsets (Forrester)
Cardiac index CI (L/min/m²)
Pulmonary capillary wedge pressure PCWP (mmHg)
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.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.