Department of Anesthesiology and Perioperative Medicine, 12311Penn State Hershey Medical Center, Hershey, PA, USA.
Department of Anesthesiology, 2090The University of Vermont Medical Center, Burlington, VT, USA.
Semin Cardiothorac Vasc Anesth. 2023 Mar;27(1):42-50. doi: 10.1177/10892532221142441. Epub 2022 Dec 6.
Preoperative cardiac evaluation is a cornerstone of the practice of anesthesiology. This consists of a thorough history and physical attempting to elucidate signs and symptoms of heart failure, angina or anginal equivalents, and valvular heart disease. Current guidelines rarely recommend preoperative echocardiography in the setting of an adequate functional capacity. Many patients may have poor functional capacity and/or have medical history such that echocardiographic data is available for review. Much focus is often placed on evaluating major valvular abnormalities and systolic function as measured by ejection fraction, but a key impactful component is often overlooked-diastolic function. A diagnosis of diastolic heart failure is an independent predictor of mortality and is not uncommon in patients with normal systolic function. This narrative review addresses the clinical relevance and management of diastolic dysfunction in the perioperative setting.
术前心脏评估是麻醉学实践的基石。这包括详细的病史和体格检查，试图阐明心力衰竭、心绞痛或等效心绞痛以及瓣膜性心脏病的迹象和症状。目前的指南很少建议在功能能力足够的情况下进行术前超声心动图检查。许多患者可能功能能力较差，/或有病史，因此可查阅超声心动图数据。通常重点评估主要瓣膜异常和射血分数测量的收缩功能，但一个关键的重要组成部分经常被忽视-舒张功能。舒张性心力衰竭的诊断是死亡率的独立预测因素，在收缩功能正常的患者中并不少见。本叙述性综述讨论了围手术期舒张功能障碍的临床相关性和管理。
