Perioperative Management of Heart Failure

Heart Failure (HF) is the outcome of most cardiovascular conditions. It is a common complication of surgery that may present in patients with the chronic form of the disease, but it may present in asymptomatic patients with preserved ejection fraction and diastolic dysfunction. Even though HF is a clinical diagnosis, the echocardiogram, and natriuretic peptides allow the classification of Left Ventricle HF (LVHF) into three different categories; HF with reduced Ejection Fraction (HFrEF), ejection fraction <40%; HF with midrange EF (HFmrEF), EF 40%-49%; and HF with preserved EF, EF>50%. Right ventricle heart failure results from abnormal RV structure, function or both and presents with symptoms similar to those of LVHF. HF is a predictor of increased perioperative risk and is higher if the patient is decompensated, has a low EF or is symptomatic. Drugs to treat pre-existing heart failure, arrhythmias, hypertension, and ischemic heart diseases should continue during the perioperative period. Anesthesiologic management must ensure the proper maintenance of organ flow and perfusion pressure. Volatile anesthetic agents offer better cardio-protection than intravenous agents, and epidural anesthesia is preferable to spinal anesthesia. The presence of abnormal perioperative filling pressures supports the early use of inotropes instead of using additional fluids to control hemodynamic alterations and avoid pulmonary edema and vascular overload. This review presents critical elements for the proper perioperative management of heart failure.

Author(s): Lempira Guevara-Matheus

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