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Anesthesia for noncardiac surgery in patients with heart failure

Author
Dirk J Varelmann, MD
Section Editor
Roberta Hines, MD
Deputy Editor
Nancy A Nussmeier, MD, FAHA

INTRODUCTION

Heart failure (HF) is a risk factor for cardiac complications after noncardiac surgery (table 1A). After major surgery, chronic stable HF is associated with two- to threefold higher 30-day mortality and hospital readmission compared with coronary artery disease (figure 1) [1,2]. Minor procedures are also associated with somewhat increased morbidity and mortality in patients with chronic stable HF [2-4]. Patients with new-onset, worsening, or acute decompensated HF are at particularly high risk for perioperative morbidity and mortality [5].

This topic will discuss anesthetic management of patients with chronic HF undergoing elective noncardiac surgery, as well as the anesthetic management of patients with acute decompensated HF undergoing urgent or emergent surgery. Recommendations for preoperative evaluation and treatment of HF by the consultant cardiologist are discussed separately.

ETIOLOGY OF HEART FAILURE

Heart failure (HF) is a common clinical syndrome caused by a variety of cardiac diseases. It can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood. (See "Epidemiology and causes of heart failure".)

Systolic HF is characterized by increased ventricular volume and reduced ejection fraction (EF). The most common causes of systolic HF are ischemic heart disease, valvular heart disease, idiopathic dilated cardiomyopathy, and hypertension. Diastolic HF is a clinical syndrome in which patients have symptoms and signs of HF with evidence of diastolic dysfunction (eg, abnormal pattern of left ventricular [LV] filling and elevated filling pressures), but normal or near normal LVEF and LV volume [6-8]. Causes of diastolic HF include ischemic heart disease, hypertension, hypertrophic obstructive cardiomyopathy, and restrictive cardiomyopathy. Many HF patients have both systolic and diastolic dysfunction. (See "Determining the etiology and severity of heart failure or cardiomyopathy", section on 'Etiology'.)

Acute decompensated HF may be precipitated by myocardial ischemia or infarction, worsening of cardiac valve dysfunction, atrial fibrillation and other arrhythmias, cardiotoxic agents, stress-induced (Takotsubo) cardiomyopathy, or rapid progression of underlying chronic HF. Noncardiac precipitants include severe hypertension, renal failure, and pulmonary emboli. (See "Evaluation of acute decompensated heart failure" and "Treatment of acute decompensated heart failure: General considerations".)

                                  

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Literature review current through: Nov 2016. | This topic last updated: Tue Jul 19 00:00:00 GMT+00:00 2016.
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