Title : Anesthetic implications of cardiac comorbidities: A review of best practices in patients with heart failure, arrhythmias, and valvular disease
Abstract:
Background and Objectives: Patients with cardiac comorbidities such as heart failure, atrial fibrillation, and valvular disease present complex challenges for perioperative management. This review highlights best anesthetic practices in these high-risk populations, drawing from current guidelines and clinical evidence to optimize intraoperative safety and postoperative outcomes.
Materials and Methods: We reviewed guidelines from the American Society of Anesthesiologists (ASA), European Society of Cardiology (ESC), and American College of Cardiology (ACC), as well as recent literature focused on perioperative risk stratification, pharmacologic interactions, and monitoring in cardiac patients undergoing surgery.
Results: In patients with reduced ejection fraction (<40%), anesthetic plans must prioritize maintaining afterload and minimizing myocardial depression. Atrial fibrillation requires careful management of rate control and anticoagulation, particularly in the context of neuraxial anesthesia. Severe aortic stenosis increases the risk of perioperative hypotension and myocardial ischemia, warranting stable hemodynamics and invasive monitoring. Drug interactions - especially with beta blockers, calcium channel blockers, ACE inhibitors, and anticoagulants - necessitate close preoperative review. Intraoperative strategies often include invasive arterial monitoring, TEE when available, and restrictive fluid strategies. Postoperative care should focus on rhythm monitoring, volume management, and resumption of cardiac medications.
Conclusions: Anesthesia in patients with cardiac comorbidities requires individualized planning grounded in multidisciplinary risk assessment and evidence-based protocols. Understanding physiologic vulnerabilities and guideline-based management helps reduce complications and improve perioperative outcomes. Future directions include more personalized algorithms and real-time monitoring tools tailored to cardiac pathology.
