Perioperative Critical Care Cardiology (eBook)

Preface to the 2nd edition 6
Preface to the 1st edition 8
Table of Contents 10
List of Contributors 12
1 Sudden Death in Heart Failure: Risk Stratification and Treatment Strategies --- M. ZECCHIN, G.VITRELLA AND G. SINAGRA 13
Definitions and Epidemiology 13
Mechanisms 15
Identifying Patients at Risk 16
Prevention 17
Pharmacologic Prevention 18
ß-blockers 19
Antiarrhythmic Drugs 20
Internal Cardioverter-Defibrillator (ICD) 21
ICD for Primary Prevention 22
ICD for Secondary Prevention 23
Role of Myocardial Revascularization for the Prevention of Sudden Death 24
Conclusions 25
References 25
2 Etiology and Pathophysiology of Heart Failure --- P. FOËX AND G.HOWARD-ALPE 33
Introduction 33
Etiology of Heart Failure 33
Cardiomyopathies 34
Myocardial Overload 35
Myocardial Ischemia and Infarction 35
Pathophysiology of Heart Failure 35
Systolic Dysfunction 38
Diastolic Dysfunction 39
Left Ventricular Inflow 40
Pulmonary Venous Flow 42
Right Ventricular Dysfunction 43
Cardiac Failure and Perioperative Risk 47
Conclusion 48
References 48
3 Cardiac Protection for Noncardiac Surgery --- P. FOËX AND G.HOWARD-ALPE 53
Introduction 53
Mechanisms of Myocardial Ischemia and Its Complications 54
Identification of High-Risk Patients 55
Coronary Revascularization or Pharmacological Prophylaxis? 57
Prophylaxis Based on Hemodynamic Stabilization 57
Nitrates 58
Calcium Channel Blockers 58
a2-Adrenoceptor Agonists 58
Adenosine Modulators 58
KATP Channel Openers 59
Na+/H+ Exchanger Blockers 59
ACE Inhibitors 59
ß-Adrenoreceptor Blockers 60
Statins 64
Aspirin 66
Conclusion 66
References 67
4 Hypertensive Urgencies and Emergencies --- J. L.ATLEE 73
Hypertension: Perspectives and Definitions 73
Perspectives 73
Definition 73
Primary vs. Secondary Hypertension 75
Complications of Hypertension 75
Hypertensive Crises: Urgencies and Emergencies 78
Definitions 78
Incidence and Causes 79
Pathophysiology 79
Manifestations and Course 80
Differential Diagnosis 81
Therapy: Perioperative Settings 82
References 86
5 Heart Failure, Atrial Fibrillation, and Diabetes Mellitus --- A.ALEKSOVA,A.PERKAN AND G.SINAGRA 89
Epidemiology of Heart Failure in Patients with Diabetes Mellitus 89
Prevalence of Atrial Fibrillation in Patients with Diabetes Mellitus 90
Mechanism of Atrial Fibrillation Development in Patients with Diabetes Mellitus and Heart Failure 91
Management of Diabetic Patients with Heart Failure and Atrial Fibrillation 92
Beta-Blockers 92
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers 93
Statins 95
Metabolic Control 95
Anticoagulant Therapy 96
Conclusions 96
References 96
6 Circulatory Failure: Bedside Functional Hemodynamic Monitoring --- C. SORBARA, S. ROMAGNOLI,A.ROSSI AND S.M. ROMANO 101
Introduction 101
Preload Reserve: Preload and Preload Responsiveness 102
Preload Responsiveness and Dynamic Parameters 104
Limitations and Pitfalls 108
Afterload Reserve and Dynamic Parameters 109
Cardiac Reserve: Contractility and Efficiency 111
Cardiac Power 111
Cardiac Cycle Efficiency (CCE) 114
Conclusions 117
References 118
7 Perioperative Cardiac Risk Stratification --- F.R.B.G.GALAS, L.A. HAJJAR AND J.O.C.AULER JR. 121
Introduction 121
Clinical Predictors of Risk 122
Type of Surgery 122
Patient’s Functional Status 124
Comorbid Diseases and Risk Factors 125
Cardiac Risk Indices and Algorithms in Noncardiac Surgery 125
Supplemental Preoperative Evaluation 131
Resting Left Ventricular Function 133
Assessment of Risk for CAD and Functional Capacity 134
Assessing and Reducing the Cardiac Risk of Noncardiac Surgery: Evidence Base 137
Preoperative Clinical Assessment: Developing Initial Estimates of Risk 137
Use of Exercise Capacity as a Preoperative Screening Tool 138
Valvular Heart Disease 138
Heart Failure 139
Systemic Hypertension 140
Pulmonary Hypertension and Congenital Heart Disease 140
Refining Initial Risk Estimates: Risk Stratification Tests 141
Approaches to Reducing Risk 142
Risk Stratification in Cardiac Surgery 142
Implications of Risk Assessment Strategies and Costs 144
References 144
8 Hemodynamic Monitoring in Patients with Acute Heart Failure --- J.-L.VINCENT AND R.HOLSTEN 147
Introduction 147
Hemodynamic Monitoring in Acute Heart Failure 148
Invasive Monitoring 148
Less-Invasive Hemodynamic Monitoring 151
Integration into Clinical Practice 153
References 154
9 Electrocardiography of Heart Failure: Features and Arrhythmias --- J. L.ATLEE 157
Heart Failure: Definitions and Perspectives 157
Electrocardiographic Features of Heart Failure 159
Left and Right Atrial Abnormalities (Enlargement) 160
Ventricular Hypertrophy and Enlargement 162
Diagnostic Criteria for Left Ventricular Hypertrophy 163
Clinical Significance of Left Ventricular Hypertrophy 4 liv 165
Conduction Disturbances and Arrhythmias in Patients with Heart Failure 166
References 168
10 Management of Patients with Acute Heart Failure --- W.G. TOLLER, G. GEMES AND H.METZLER 171
Introduction 171
Definition and Etiology of AHF 172
Pathogenesis of AHF 173
Diagnosis and Monitoring 174
Basic Monitoring 174
Biochemical Markers 174
Echocardiography 175
Central Venous and Pulmonary Artery Catheterization 175
Angiography 176
Therapeutic Approaches 176
General Principles 176
Ventilatory Assistance 177
Volume Management 177
Drugs for the Treatment of AHF 177
Diuretics 178
Vasodilators 178
Mechanical Assist Devices 181
References 183
11 Pacemaker and Internal Cardioverter-Defibrillator Therapies --- J. L.ATLEE 187
Pacing for Hemodynamic Improvement 189
Pacing for Bradycardia 189
Hypertrophic Obstructive Cardiomyopathy 189
Cardiac Resynchronization Therapy 190
Pacing to Prevent Atrial Fibrillation 196
Pacing in Long QT Interval Syndromes 197
ICD Therapy 198
ICD Design and Function 198
Indications for ICD Therapy 199
Randomized Clinical Trials of ICD Therapy 199
Who Is Expected to Benefit from ICD Therapy? 202
Combined ICD-CRT Therapy 203
Summary and Conclusions 204
References 204
12 Updates on Cardiac Arrest and Cardiopulmonary Resuscitation --- G. RISTAGNO, A.GULLO, W.TANG AND M. H.WEIL 207
Introduction 207
Major Changes in the 2005 Cardiopulmonary Resuscitation Guidelines 208
Precordial Compression 209
Timing of Defibrillation and Defibrillation Algorithm 210
Limitations of Epinephrine 213
Additional Measurements to Improve Outcome of CPR 215
Conclusions 217
References 217
13 Circulatory Shock: Hypovolemic, Distributive, Cardiogenic, Obstructive --- J.-L.VINCENT AND A. RAPOTEC 223
Introduction 223
Pathophysiological Classification of Shock 223
Diagnosis and Monitoring 225
Clinical Signs of Shock 225
Hemodynamic and Laboratory Parameters of Shock 226
Mixed Venous Oxygen Saturation 227
Treatment 229
Cardiorespiratory Support 230
Correction of the Underlying Cause 233
Complications of Circulatory Shock 233
Conclusion 234
References 234
14 Prevention and Management of Cardiac Dysfunction during and after Cardiac Surgery --- W.MOOSBAUER, A.HOFER AND H.GOMBOTZ 237
Introduction 237
Causes of Postoperative Myocardial Dysfunction and Failure 239
Prebypass Ischemia 240
ECC and Cardiac Arrest 241
Inadequate Cardioplegic Arrest 241
Hypothermia 242
Reperfusion 243
Prevention of Postoperative Myocardial Dysfunction and Failure 244
Role of the Anesthesiologist in Myocardial Protection 245
Role of the Surgeon in Myocardial Protection 249
References 250
15 Management of Systemic and Pulmonary Hypertension --- P. GIOMARELLI, S. SCOLLETTA AND B. BIAGIOLI 255
Systemic Hypertension 255
Introduction 255
Hypertension and Pulse Wave Analysis 256
Therapeutic Strategies 259
Hypertensive Crisis and Urgency 259
Perioperative Hypertension 263
Pulmonary Hypertension 264
Introduction 264
Symptoms, Signs, and Clinical History 266
Diagnostic Methods 266
Treatment 268
References 274
16 Recent Advances in the Natural History of Dilated Cardiomyopathy: A Review of the Heart Muscle Disease Registry of Trieste --- M.MORETTI, A.DI LENARDA AND G. SINAGRA 279
Introduction 279
Patients and Methods 279
Results 280
Change in the Natural History of DCM in the Last 25 Years 281
Role of Early Treatment 283
Natural History of Familial DCM 283
Prognostic Significance of Left Ventricular Filling 284
Ventricular Arrhythmias and SD 285
Conclusions 286
References 287
Subject Index 291