Management of diastolic heart failure following cardiac surgery

Abstract

A considerable number of patients who undergo cardiac surgery have a variety of comorbid conditions that includes diastolic dysfunction. Abnormalities of diastolic function may lead to diastolic heart failure that can complicate their postoperative course. This form of failure occurs more commonly in patients with hypertensive or valvular heart disease, diabetes mellitus, myocardial ischaemia, as well as in hypertrophic or restrictive cardiomyopathy, and is more prevalent in the elderly. In spite of it being a common cause of heart failure it remains underreported in the postoperative heart. We reviewed relevant literature analysing the different therapeutic approaches and formulated a management plan for diastolic heart failure in the postoperative heart in the intensive care environment based on the most current understanding of this form of cardiac failure.

Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

“…Approximately 40% to 50% of patients with a preoperative creatinine level >2.5 mg/dL require hemodialysis postoperatively [37]. An under-appreciated risk factor in the older adult is diastolic heart failure, often secondary to long-standing hypertensive cardiomyopathy [41]. This condition can make postoperative management extremely challenging.…”

Heart Failure With Preserved Ejection Fraction: A Perioperative Review

“…60 It is important to optimize comorbid conditions before surgery, including aggressive control of chronically uncontrolled hypertension and avoidance of significant hyperglycemia. Sinus rhythm should be restored if possible, and the atrial fibrillation rate should be controlled.…”

Perioperative Care of the Patient with Diastolic Heart Failure

“…The most common causes of systolic dysfunction are ischemic heart disease, idiopathic dilated cardiomyopathy, hypertension, and valvular heart disease, whereas the most common causes of diastolic dysfunction are ischemic heart disease, hypertrophic and restrictive cardiomyopathies, and hypertension 6 . Risk factors for DHF include aging, being female, hypertension, increased left ventricular mass, diabetes, obesity, and ischemic heart disease 18 …”

“…For more than three decades, the presence of signs and symptoms of heart failure has been associated with increased perioperative cardiovascular risk for noncardiac surgery, and heart failure in the absence of coronary artery disease is an important predictor of adverse outcomes 22 . Few studies have been performed to assess the differences between surgical patients with SHF versus DHF, but it is important to be able to recognize DHF and differentiate it from the systolic counterpart because, even though the manifestations can be somewhat similar, management is different 18 …”

“…During the perioperative period, it is important for perioperative nurses to identify patients who may have or may be at risk for DHF to help prevent any further deterioration of diastolic function in the postoperative period 18 . Understanding the pathophysiology of heart failure is imperative for the perioperative nurse when he or she is obtaining a thorough patient history and performing a physical examination before surgery.…”