J Anesth Perioper Med. 2018;5(4):186-199. https://doi.org/10.24015/ebcmed.japm.2018.0074

Heart Failure: Mechanisms, Treatment, and Anesthesia Management

Xianfeng Ren1, and Wei Dong Gao2

From the 1Department of Anesthesiology, China-Japan Friendship Hospital of Beijing, Beijing, China; 2Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Correspondence to Dr. Wei Dong Gao at wgao3@jhmi.edu.

EBCMED ID: ebcmed.japm.2018.0074 DOI: 10.24015/ebcmed.japm.2018.0074


Aim of review
To update our understanding of the pathogenesis and mechanisms of heart failure with reduced ejection fraction (HFrEF), treatment, and issues pertaining to the perioperative care of these patients.

We conducted a comprehensive review of the current literature, including both original basic and clinical studies on HFrEF from basic mechanisms of its development to clinical treatments. We used PubMed as the main database. We found over 5000 publications with the keyword “heart failure with reduced ejection fraction,” including original research, meta-analyses, and review studies. We selected recent reviews, recent original studies (basic and clinical), and past landmark original studies (basic and clinical) over the past 10 years. We also reviewed the literature on some specific issues regarding the perioperative care of patients with heart failure.

Recent findings
HFrEF presents perioperative challenges to anesthesiologists. It is characterized by chamber dilatation with low contractility and altered cardiac excitation-contraction coupling processes. Treatments for HFrEF consist of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers and β blockers at early stages, and device therapies and heart transplantation at more advanced stages. Novel therapies are being investigated as well. Specific perioperative care for patients with HFrEF includes preoperative optimization, maximization of myocardial protection, minimization of myocardial injury, appropriate use of positive inotropic agents, proper fluid management, and management of device therapies.

The pathophysiology of heart failure involves activation of multiple signaling pathways and significant alterations in excitation-contraction coupling. Perioperative care of patients with heart failure is challenging and requires an understanding of the basic mechanisms of heart failure. Moreover, practitioners should be able to stratify and minimize risk, optimize and manage compromised patients, and prevent the worsening of symptoms and complications. (Funded by the American Heart Association.)

Article Type
Review Article

Declaration of Interests
The author declares no conflicts of interest.

This study was supported by the American Heart Association (grant 17GRNT33670387 to Dr. Wei Dong Gao).

This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.