Two main Categories are:

• Congestive Heart Failure or
• Cardiomyopathy Ischemic Heart Disease ASHD/CAD

1. Dyspnea with minimal exertion & O2.
2. Has been optimally treated with diuretics & vasodilators.
3. Ejection fraction <20%.
4. If CHF: Evidence of fluid overload in spite of medications.
5. If CAD: History of angina, arrhythmias, previous MI.
6. Angina syndrome present even at rest.

1. Dyspnea at rest.
2. Oxygen dependent.
3. FEV less than 30% of predicted.
4. Hypoxemia: pO2 ≤ 55 mmHg or O2 SAT ≤ 88%
5. Hypercapnia: pCO ≥ 50 mmHg.
6. Unintentioned wt. loss of >10% of body wt. over last 6 months
7. Resting pulse >100/min

1. PT>5 sec over control or INR >1.5 and serum albumin <2.5 gm/dl
2. Ascites, recurrent or refractory to tx.
3. Hepatorenal syndrome (<BUN, <Cr, >urine)
4. Hepatic Encephalopathy .

1. Ability to speak limited to six words.
2. Lost ability to eat, walk and sit up without assistance.
3. Markedly decreased nutritional intake.
4. Urinary and fecal incontinence.

1. No Dialysis.
2. And either (acute):
   • BUN>100, Creatinine >8.0mg/dl & Creatinine clearance <10cc/min.
   • Serum creatinine >8.0mg/dl
   • Estimated glomerular filtration rate (GFR) < 10ml/min
3. And either (chronic)
   • Creatinine clearance <10cc/min or <15cc/min with CHF comorbidity
   • Serum creatinine >8.0 mg/dl
   • Signs & symptoms of renal failure
   • GFR <10 ml/min