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Published on: November 28, 2018
Diastolic dysfunction, diagnostic and perioperative management in cardiac surgery
Alina Nicoara1, Madhav Swaminathan
1Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
Insights
Diastolic dysfunction poses a significant perioperative risk, potentially leading to acute decompensation. Early detection and understanding of diastolic function are crucial for effective patient management and improved outcomes.
Area of Science:
- Cardiology
- Anesthesiology
- Perioperative Medicine
Background:
- Left ventricular diastolic dysfunction is often underestimated.
- It is linked to adverse outcomes in patients undergoing various surgical procedures.
- Diastolic dysfunction increases the risk of perioperative acute decompensation.
Purpose of the Study:
- To review recent findings on the role of diastolic dysfunction in the perioperative period.
- To discuss recent advances in the diagnosis and management of diastolic function.
- To highlight the importance of physician awareness and knowledge regarding diastolic dysfunction.
Main Methods:
- This review synthesizes current literature on diastolic dysfunction.
- It focuses on diagnostic advancements and perioperative management strategies.
- The review examines the implications of diastolic dysfunction grading systems.
Main Results:
- Recent diagnostic advancements have limited intraoperative applicability.
- Perioperative management strategies are primarily preventive and symptomatic due to a lack of disease-specific therapies.
- Diastolic dysfunction is associated with poorer outcomes in both cardiac and noncardiac surgery patients.
Conclusions:
- Perioperative physicians must be aware of diastolic dysfunction and its implications.
- Knowledge of diastolic dysfunction grading systems is essential for appropriate patient care.
- Understanding the pathophysiologic changes associated with diastolic dysfunction is critical for optimizing perioperative management.
Purpose Of Review:
The review focuses on recent findings on the role of diastolic dysfunction in the perioperative period and on recent advances in the diagnosis and perioperative management of diastolic function.
Recent Findings:
Left ventricular diastolic dysfunction is an underestimated disease with a high risk for acute decompensation in the perioperative period. It has been associated with adverse outcomes in patients undergoing cardiac or noncardiac procedures. Recent advancements in the diagnosis of diastolic function have limited intraoperative applicability. Due to the lack of disease-specific therapies, perioperative management is preventive and symptomatic.
Summary:
Appropriate perioperative patient care requires that the perioperative physician be alerted to the presence of diastolic dysfunction, be knowledgeable of the diastolic dysfunction grading system and understand the pathophysiologic changes associated with various grades of diastolic function.
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