Perioperative Heart Failure and Methods of Support

Abstract

The term (Heart Failure) is often vaguely listed on the pre-anesthesia record and poorly characterized in patients for non-cardiac surgery. Furthermore, many aspects of heart failure are poorly understood. Every anesthesia provider must be familiar with the definition, classification, pathogenesis, and treatment strategies associated with HF. In contrast to the common clinical presentation of heart failure, the causes of heart failure are widely variable. Growing evidence suggests that there are unique characteristics in risk factors, pathophysiology, treatment, and outcomes in systolic vs. diastolic heart failure. While there is no single test that confirms the diagnosis of heart failure, the categorical feature of systolic HF is an EF (ejection fraction) less than 40%, compared to an EF greater than 50% in diastolic HF, while individuals with an EF between 41 and 49% are considered intermediate. Conclusion: In patients with a moderate or poor functional capacity, consider the risk of the surgical procedure. Patients scheduled for intermediate-risk surgery can proceed for surgery; statin therapy and a titrated low-dose β-blocker regimen appears appropriate prior to surgery.