How does congestive heart failure affect perioperative cardiac management?

Updated: Feb 04, 2019
  • Author: Davinder Jassal, MD; Chief Editor: William A Schwer, MD  more...
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Answer

The mortality rate following noncardiac surgery increases with advancing New York Heart stage. The perioperative mortality rate appears to be more dependent on the patient's condition at the time of surgery rather than on the myocardial depressant effects of the anesthesia. CHF should be aggressively and adequately treated before the patient undergoes major elective surgery. Therapy is aimed at reducing ventricular filling pressures in addition to improving cardiac output. Medications proven to show a morbidity and mortality benefit include ACE inhibitors, beta-blockers, spironolactone, and angiotensin receptor blockers. Digoxin and diuretics have been shown to improve morbidity rates without reducing mortality rates. In a 1986 report, Detsky et al suggest that patients with decompensated CHF should be stabilized for at least 1weekbeforeundergoingelective surgery. [3, 4]


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