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Revista Med
Print version ISSN 0121-5256On-line version ISSN 1909-7700
Abstract
LOPEZ GARZON, Nelson Adolfo and ADOLFO ANGEL, Gustavo. Heart failure with preserved ejection fraction: overview and perioperative management. Rev. Med [online]. 2020, vol.28, n.2, pp.49-60. Epub June 04, 2021. ISSN 0121-5256. https://doi.org/10.18359/rmed.4854.
Heart failure with preserved ejection fraction (HFPEF) is frequent and challenging to manage in the adult population during the perioperative period. It is a complex clinical syndrome with structural and functional cardiac abnormalities with left ventricular preserved ejection fraction (LVPEF) ≥ 50%. Biomarkers, echocardiography, cardiac catheterization, and other noninvasive methods confirm the diagnosis. Currently, there is no specific effective management compared to failure with reduced LVPEF.
Aim:
To prepare a literature review of HFpEF and its anesthetic implications.
Methods:
A non-systematic literature review was carried out in the following databases: Pubmed/Medline, LILACS, ScienceDirect.
Results:
HFpEF is a common entity with a prevalence between 36.9 % and more than 50 % of all patients. The pathophysiology includes diastolic alterations of the cardiac cycle, including relaxation and ventricular compliance phases. From the anesthetic point of view, sinus rhythm should be maintained in arrhythmias, chronotropic response controlled, pulmonary congestion avoided, etiologies/comorbidities specifically managed, ventricular filling pressures preserved, and hemodynamic stability achieved.
Conclusion:
Patients with HFPEF represent an anesthetic challenge. Management includes specific treatment of etiologies, comorbidities, and phenotypes. Unlike heart failure with reduced ejection fraction, there are no therapies that reduce mortality, so new drugs and clinical studies are required to improve anesthetic prospects and therapeutic management.
Keywords : preserved ejection fraction; heart failure; anesthesia; diastolic dysfunction; perioperative period.
