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🫀 Acute MI Hemodynamic Subsets (Forrester)

UseUse with invasive (or bedside-approximated) hemodynamics to place a patient in one of four subsets and direct…

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SourceForrester JS, et al. Medical therapy of acute MI. N Engl J Med 1976.

Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders

This-shift next steps

After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.

Scene next step
📋Upper GI bleedOpen scene pack →
Related scores
Matching pathway
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Score + version; reference only — not a substitute for care · no HIS write

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Methodology · worked example, guidelines & full notes
Clinical takeaway

The bedside 'warm/cold · wet/dry' (Nohria-Stevenson) scheme approximates Forrester without a pulmonary artery catheter (original synthesis · not guideline verbatim).

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

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 CI2.0 L/min/m²
Pulmonary capillary wedge pressure PCWP22 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
Verification & sources · governance
FAQ

Frequently asked questions

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.
Does Acute MI Hemodynamic Subsets (Forrester) upload patient data? Where is it calculated?
Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
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）
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