We owe a lot to our past genius minds for our current understanding of cardiology.Youngsters should know how the filed of cardiology evolved .Few great brains taught us how to think hemodynamically in the setting of STEMI.
The Diamond and Forrester classification is an undisputed achievement of modern cardiac hemodynamics.They gently converted the clinical classification of Killip into more scientific hemodynamic one .Both these classification continue to fascinate us even in the era of instant PCI for STEMI .
And youngsters should read this again and again and critically evaluate their patients within this system.The two key parameters he used was PCWP of 18mmhg /And cardiac Index 2.2liters . He also suggested a simplified version where intra- arterial monitoring is not feasible. The cardiac Index could be replaced by systemic blood pressure lung congestion represents PCWP >18mmhg .
The DF classification would become
An important inference from DF classification !
The class 3 of DF grading has no pulmonary congestion but persistent hypotension . What does it mean ?
It is a stunning proof of a great concept. As the patient moves (Worsens) from DF two to DF three , the lung congestion tends to regress . This sub-set actually means development of bi-ventricular failure or isolated RV failure . This is an ominous sign and indicate a bad prognosis . ( One may call it a paradox , according to conventional thinking “The more the lung crackles , dismal is the outcome” DF grading clearly proves this is not always true , as long as the systemic pressure is maintained crackles can be managed effectively . In DF 3 the right ventricle as a pump is becoming so weak it is not able to congest the lungs at the same process leads to systemic hypotension.
Forrester is also a pioneer in how we evaluate chest pain in the emergency rooms and cardiology OPDs . His thoughts on utilization of Besean theorem revolutionized the interpretation of exercise stress testing.
* Killip is a genius of different caliber would be discussed later .