Novel Perioperative Pharmacologic Therapy Of Heart Failure

Heart failure (HF) is a pathophysiological condition with an inability of the heart to fill or eject blood sufficient to meet metabolic demands. The etiology of HF appears evenly distributed between systolic and diastolic dysfunction and currently is the only cardiac condition with an increasing mortality rate. As the elderly population grows, so will the frequency of HF patients presenting to the hospital and operating room. An insult to the heart (ischemia, hypertension, virus, pregnancy, hemochromatosis, idiopathic) causes left ventricular (LV) dysfunction and a reduction in cardiac output with secondary neurohormonal activation (sympathetic nervous system; renin-angiotensin-aldosterone system or RAAS; vasopressin; endothelin; cytokines) and alterations in renal tubular sodium and water retention. This viscious cycle markedly alters left ventricular (LV) loading conditions and becomes a progressive disorder with LV remodeling, fibrosis, dilation, and failure.