Read the profile. Fine-tune the treatment.
Six patients who are already on medication. Read each one's Electrical Cardiometry profile, decide what you would change, and see how the profile would be expected to respond, with the reasoning and the evidence behind it.
How EC profiles guide medication
Blood pressure is flow times resistance. The same reading can come from a fast, forceful heart, from tight vessels, or from too much or too little fluid, and each calls for a different drug class. A hemodynamic profile shows which mechanism is driving the problem, and whether a drug already on board is overshooting.
Teaching scenarios; not bedside decision support; expected responses are illustrative. No doses are given, only class-level actions such as reduce, switch to or add. Treatment decisions follow guidelines, local protocols and the whole clinical picture.
| Profile | What the profile shows | Drug-class logic | Source |
|---|---|---|---|
| High resistance | SVRI above 2500 dyn·s·cm⁻⁵·m² | ACE inhibitor or ARB, with or without a dihydropyridine calcium-channel blocker | Krzesiński 2013 (doi) |
| Hyperdynamic | CI above 4.2 L/min/m² and/or heart rate above 80 bpm | Beta-blocker | Krzesiński 2013 |
| Volume excess | Thoracic fluid content (TFC) raised | Thiazide diuretic | Krzesiński 2013 |
| Low output on a beta-blocker | CO or CI low | Reduce the beta-blocker | Nassef 2026 (doi) |
| Dry chest on a diuretic | TFC low | Reduce the diuretic | Nassef 2026 |
| Heart failure, wet and warm | TFC high, CI adequate | Loop diuretic, titrated as TFC falls | Nohria 2003 (doi); ESC 2021 (doi) |
| Heart failure, high resistance | SVRI high with adequate blood pressure | Vasodilator or afterload reduction, within guideline therapy | Nohria 2003; ESC 2021 |
| Heart failure, cold and hypotensive | Low CI with systolic pressure below 90 mmHg | Inotrope in hospital; not routine | ESC 2021 |
| Septic shock, low pressure | MAP below 65 mmHg | Norepinephrine first | Surviving Sepsis 2021 (doi) |
| Septic shock, pump failure | Persistent hypoperfusion and low CI despite adequate volume and MAP, with cardiac dysfunction | Add dobutamine (or use epinephrine alone) | Surviving Sepsis 2021 |
| Fluid decision | Passive leg raise lifts stroke volume by 10% or more | Fluid likely to raise output; stop when stroke volume no longer rises and TFC climbs | Monnet 2016 (doi) |
| Hypertensive pregnancy, high output | High CO, lower SVR | Labetalol | Stott 2017 (doi); Kalafat 2020 (doi) |
| Hypertensive pregnancy, high resistance | High SVR, low CO | Nifedipine; avoid lowering output further | Stott 2017; Kalafat 2020 |
Where the cut-offs come from. The hypertension thresholds (SVRI 2500, CI 4.2, heart rate 80) come from impedance-cardiography treatment algorithms used in the trials, not from thresholds validated on the ICON or ICONCORE. Electrical Cardiometry measures the same quantities by a related method, but no study has set EC-specific treatment cut-offs, and TFC has no universal normal range. Use the numbers as anchors for reasoning, compare readings in the same patient over time, and let guidelines choose the drug.
How the numbers in the cases are built
Every profile below is internally consistent: heart rate, stroke volume and pressures are the inputs, and the rest is calculated. You can check any case by hand.
MAP ≈ DBP + (SBP − DBP) / 3
SVR (dyn·s·cm⁻⁵) = 80 × (MAP − CVP) / CO
CI = CO / BSA · SVRI = SVR × BSA
CVP is stated for each case, assumed when the patient has no central line. Colour flags use teaching ranges: heart rate below 60 or above 100; MAP below 65 or above 105; CI below 2.5 or above 4.2; SVRI below 1700 or above 2500. TFC is flagged from the clinical context of each case.
What the evidence does and does not show
Hypertension
In a randomised trial of resistant hypertension, profile-guided treatment controlled pressure in 56% versus 33% with specialist care (Taler 2002, n=104). The CONTROL trial found 77% versus 57% (Smith 2006, n=164; industry-funded). A meta-analysis gave an odds ratio of 2.41 for control (Ferrario 2010). Dr. Nassef's retrospective series is early, single-centre experience (Nassef 2026, n=156). No study has shown fewer strokes, heart attacks or deaths.
Heart failure
The warm/cold, wet/dry profiles (Nohria 2003) map onto diuretics, vasodilators and, rarely, inotropes; drug choice follows the ESC guideline (ESC 2021). The strongest evidence for hemodynamic-guided heart failure care comes from an implanted pulmonary artery pressure sensor (CHAMPION 2011), not from Electrical Cardiometry.
Septic shock
Norepinephrine first, dobutamine added for persistent hypoperfusion with cardiac dysfunction (Surviving Sepsis 2021). A leg raise that lifts stroke volume 10% or more predicts a fluid response (Monnet 2016). In FRESH, leg-raise-guided resuscitation gave less fluid, with less dialysis and ventilation (Douglas 2020), but it used bioreactance, a different technology from EC.
Hypertensive pregnancy
Observational studies suggest high-output hypertension responds to labetalol, while a high-resistance, low-output profile does better with a vasodilator such as nifedipine (Stott 2017; Kalafat 2020). A systematic review rates this evidence low-certainty (Novelli 2026).
Haemodialysis
TFC measures fluid in the chest, not in the whole body, so it cannot set a patient's dry weight on its own. Bioimpedance-guided fluid management did not reduce deaths in a meta-analysis (Covic 2017). Use it as an adjunct to clinical assessment only.
About the "after" profiles
The expected responses below show the direction and rough size of change that the physiology predicts for each choice. They are not outputs of a validated model and not what any individual patient will do. Real responses vary, take hours to weeks, and must be measured, not assumed.
Six patients, already on treatment
Pick a patient, read the current medicines and the profile, then choose what you would change. You can try every option: each one shows the expected profile beside the current one, and why it helps or does not.
Teaching scenarios; not bedside decision support; expected responses are illustrative.