[Perioperative heart failure - acute intraoperative heart failure]

With respect to the fact that - with the notable exception of patients undergoing cardiac surgery - only sparse data and limited guideline recommendations on optimal treatment strategies in patients with intraoperative acute heart failure are available. Consecutively it is rather difficult to make clear suggestions for the optimal treatment of this complication. However, data based on treatment of medical patients with acute heart failure suggest that it may be reasonable first to echocardiographically determine the specific cardiac pathology, especially with respect to systolic and diastolic function and/or presence of acute myocardial ischemia and subsequently treat the specific problem in a goal-directed approach. Importantly, one has to to take into account that the use of beta-mimetic drugs for the treatment of acute heart failure is increasingly recognized as an isolated mortality factor. This suggests to use inotropes as restrictive as possible, and if inotropic treatment becomes inevitable, to use levosimendan as the only inotrope that has been shown to improve mortality in several meta-analyses.