oa Southern African Journal of Anaesthesia and Analgesia - Perioperative cardiac care - not just systolic : SASA refresher course texts



Revised guidelines for the management of heart failure (HF) were published in 2013. HF arises due to a reduction in cardiac output secondary to a reduction in stroke volume (SV). Systolic HF (SHF) arises due to overfilling of a dilated left ventricle (LV) and/or right ventricle with inadequate ejection, and thus a reduced ejection fraction (EF). SHF progressively limits activity and results in increasing back pressure and secondary congestion of the pulmonary and/or systemic venous circulation. However, the majority of patients with HF have preserved or even exaggerated systolic function, with a normal or increased EF owing to diastolic heart failure (DHF). SV is reduced because of underfilling of a stiff LV. Sudden-onset dyspnoea in response to stress or exercise occurs as a result of raised LV end-diastolic pressure (LVEDP). Congestion owing to an intermittent or persistent increase in LVEDP is thus an early, prominent feature of diastolic dysfunction.


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