Acute perioperative heart failure.

Area of Science:

• Cardiology
• Perioperative Medicine
• Critical Care

Background:

• Heart failure prevalence is rising due to advances in treating coronary artery disease, hypertension, and diabetes.
• Patients with chronic heart failure face significant perioperative risks, including acute decompensation.
• Even patients without prior heart issues can develop severe complications like myocardial infarction and acute heart failure during surgery.

Purpose of the Study:

• To review the challenges and advances in managing heart failure patients undergoing non-cardiac surgery.
• To evaluate diagnostic tools and therapeutic strategies in the perioperative setting for heart failure.
• To discuss the evolving landscape of perioperative cardiac care.

Main Methods:

• Review of current literature on heart failure management in surgical patients.
• Analysis of diagnostic utility of B-type natriuretic peptide testing in the perioperative period.
• Evaluation of novel therapeutic agents, such as levosimendan, for perioperative heart failure.

Main Results:

• Patients with pre-existing heart failure undergoing non-cardiac surgery experience significant morbidity and mortality.
• Heart failure is an independent risk factor, with outcomes similar to patients with coronary artery disease but no heart failure.
• The role of B-type natriuretic peptide testing for diagnosing myocardial contractile dysfunction perioperatively is uncertain.
• Levosimendan shows promise as a positive inotropic agent for perioperative support.

Conclusions:

• B-type natriuretic peptide testing in the perioperative setting is limited by confounding variables.
• New positive inotropic therapies are emerging as potentially safer alternatives to older treatments.
• Optimizing perioperative care for heart failure patients remains a critical clinical challenge.