Heart Failure

Question 1

Anesthetic goals in HF

Answer 1

The goal is to prevent and avoid myocardial depression:

	1. Heart rate	-	normal to elevated
	2. Preload	-	normal to high
	3. Afterload	-	low
	4. Contractility-	increase

Question 2

Anesthetic management in HF

Answer 2

Maintain medication therapy, esp. beta blockers
Hypotension treated with ephedrine, phenylephrine, vasopressin
General anesthetic doses may be decreased
Positive pressure ventilation beneficial in decreasing pulmonary congestion
Regional anesthesia ok
Avoid fluid overload
+/- A-line

Question 3

Anesthetic goals in hypertrophic cardiomyopathy

Answer 3

Minimize LV outlet obstruction

Mild myocardial contractility depression
Minimal effects on preload and afterload

Question 4

Anesthetic management in hypertrophic cardiomyopathy

Answer 4

Volatile anesthetics good
A-line
Treat hypotension with alpha adrenergic agonists (phenylephrine) and VOLUME
Beta adrenergic agonists are contraindicated
Prompt replacement of blood and fluids
Avoid vasodilators
Maintain NSR

Question 5

Dilated cardiomyopathy goals?

Answer 5

Myocardial disease with LV or biventricular dilation, systemic dysfunction, and normal LV thickness
Anesthesia: The goal is to prevent and avoid myocardial depression:
1. Heart rate-normal to elevated
2. Preload -normal to high
3. Afterload -low
4. Contractility-increase

Question 6

Cor Pulmonale goals?

Answer 6

Eliminate any infection
Reverse bronchospasm
Improve expectoration
Maintain good oxygenation, hydration and lung mechanics
Correct electrolyte imbalance

Question 7

Cor Pulmonale anesthetic management?

Answer 7

Oxygenation
Avoid histamine releasers
Depth of anesthetic
Bronchodilator effects of IAs
A-line
TEE for monitoring RV function
High level block with regional should be avoided, otherwise ok