
Contents
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Ischaemic heart disease Ischaemic heart disease
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Perioperative risk of myocardial ischaemia Perioperative risk of myocardial ischaemia
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Functional capacity Functional capacity
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Clinical risk indices Clinical risk indices
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Perioperative testing Perioperative testing
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Special investigations Special investigations
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12-lead electrocardiogram 12-lead electrocardiogram
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Cardiac biomarkers Cardiac biomarkers
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Assessment of LV function Assessment of LV function
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Coronary CT angiography Coronary CT angiography
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Exercise ECG Exercise ECG
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CPET CPET
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Pharmacological stress testing Pharmacological stress testing
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Preoperative coronary artery revascularisation Preoperative coronary artery revascularisation
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Percutaneous coronary intervention Percutaneous coronary intervention
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Coronary artery bypass grafting Coronary artery bypass grafting
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Perioperative MACE risk modification Perioperative MACE risk modification
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Anaesthetic considerations Anaesthetic considerations
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Perioperative acute myocardial ischaemia and infarction Perioperative acute myocardial ischaemia and infarction
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Acute myocardial infarction (AMI) Acute myocardial infarction (AMI)
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Immediate management Immediate management
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Myocardial injury after non-cardiac surgery Myocardial injury after non-cardiac surgery
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Diagnostic criteria, Diagnostic criteria,
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Routine postoperative surveillance Routine postoperative surveillance
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Medical management Medical management
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Heart failure Heart failure
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Left ventricular heart failure (LVHF) Left ventricular heart failure (LVHF)
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Management, Management,
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Medical treatment of HFrEF Medical treatment of HFrEF
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Device treatment Device treatment
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Medical treatment of HFpEF and HFmrEF Medical treatment of HFpEF and HFmrEF
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Right-sided heart failure Right-sided heart failure
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Signs and symptoms of RHF Signs and symptoms of RHF
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Investigations Investigations
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Medical management Medical management
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Perioperative management Perioperative management
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Hypertension Hypertension
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Perioperative management Perioperative management
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Valvular heart disease Valvular heart disease
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The patient with an undiagnosed murmur The patient with an undiagnosed murmur
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Prosthetic valves Prosthetic valves
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Aortic stenosis Aortic stenosis
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History and examination History and examination
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Investigations Investigations
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Perioperative management,, Perioperative management,,
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Risk Risk
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Haemodynamic goals Haemodynamic goals
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Perioperative Perioperative
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Aortic regurgitation Aortic regurgitation
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Pathophysiology Pathophysiology
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Acute AR (e.g. endocarditis or acute type A aortic dissection) Acute AR (e.g. endocarditis or acute type A aortic dissection)
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Chronic AR Chronic AR
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History, examination and investigations History, examination and investigations
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Perioperative risk Perioperative risk
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Haemodynamic goals Haemodynamic goals
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Mitral stenosis Mitral stenosis
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History History
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Examination Examination
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Investigations Investigations
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Perioperative risk Perioperative risk
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Haemodynamic goals Haemodynamic goals
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Mitral regurgitation Mitral regurgitation
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History, examination and investigations History, examination and investigations
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Mitral valve prolapse Mitral valve prolapse
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Perioperative risk Perioperative risk
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Haemodynamic goals Haemodynamic goals
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Pericardial disease Pericardial disease
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Acute pericarditis Acute pericarditis
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Constrictive pericarditis Constrictive pericarditis
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Pericardial effusion Pericardial effusion
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Cardiomyopathy Cardiomyopathy
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Stress-induced cardiomyopathy Stress-induced cardiomyopathy
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Restrictive cardiomyopathy Restrictive cardiomyopathy
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Haemodynamic goals Haemodynamic goals
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Dilated cardiomyopathy Dilated cardiomyopathy
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Haemodynamic goals Haemodynamic goals
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Hypertrophic obstructive cardiomyopathy Hypertrophic obstructive cardiomyopathy
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Haemodynamic goals Haemodynamic goals
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Patients with a transplanted heart Patients with a transplanted heart
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Altered physiology Altered physiology
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Immunosuppression Immunosuppression
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Effects of treatment Effects of treatment
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Associated risk factors Associated risk factors
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Choice of technique Choice of technique
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Congenital heart disease and non-cardiac surgery Congenital heart disease and non-cardiac surgery
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General considerations General considerations
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Preoperative assessment Preoperative assessment
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Factors suggestive of increased perioperative risk Factors suggestive of increased perioperative risk
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Specific considerations Specific considerations
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Specific congenital heart disease lesions Specific congenital heart disease lesions
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Atrial septal defect (secundum type) Atrial septal defect (secundum type)
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Atrial septal defect (primum type) Atrial septal defect (primum type)
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Ventricular septal defect Ventricular septal defect
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Patent ductus arteriosus Patent ductus arteriosus
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Tetralogy of Fallot Tetralogy of Fallot
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Transposition of the great arteries Transposition of the great arteries
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Hypoplastic left heart syndrome and the Fontan circulation Hypoplastic left heart syndrome and the Fontan circulation
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Adults with congenital heart disease Adults with congenital heart disease
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Uncorrected disease Uncorrected disease
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Corrected disease Corrected disease
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Palliated disease Palliated disease
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Pulmonary hypertension Pulmonary hypertension
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Symptoms and signs Symptoms and signs
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Diagnosis of pulmonary hypertension Diagnosis of pulmonary hypertension
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Other tests should then be used to delineate the aetiology Other tests should then be used to delineate the aetiology
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Severity Severity
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Treatment Treatment
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Anaesthesia Anaesthesia
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Risk factors associated with increased perioperative mortality and morbidity Risk factors associated with increased perioperative mortality and morbidity
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Perioperative management Perioperative management
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Pregnancy and pulmonary hypertension Pregnancy and pulmonary hypertension
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Perioperative arrhythmias Perioperative arrhythmias
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Practical diagnosis of arrhythmias Practical diagnosis of arrhythmias
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Determine Determine
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Ventricular rate Ventricular rate
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QRS complex QRS complex
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Regularity Regularity
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P waves P waves
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Atrial/ventricular activity Atrial/ventricular activity
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Narrow complex arrhythmias Narrow complex arrhythmias
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Sinus arrhythmia Sinus arrhythmia
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Sinus bradycardia Sinus bradycardia
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Sick sinus syndrome Sick sinus syndrome
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Atrial ectopics Atrial ectopics
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Long QT syndrome Long QT syndrome
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Regular supraventricular tachycardia Regular supraventricular tachycardia
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Sinus tachycardia Sinus tachycardia
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AV nodal re-entry tachycardia AV nodal re-entry tachycardia
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AV re-entry tachycardia AV re-entry tachycardia
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Wolff–Parkinson–White (WPW) syndrome Wolff–Parkinson–White (WPW) syndrome
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Atrial flutter Atrial flutter
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Irregular supraventricular tachycardia Irregular supraventricular tachycardia
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Atrial fibrillation Atrial fibrillation
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Management of acute atrial fibrillation Management of acute atrial fibrillation
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Acute ventricular rate control Acute ventricular rate control
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Acute rhythm control Acute rhythm control
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Broad complex arrhythmias Broad complex arrhythmias
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Ventricular ectopics Ventricular ectopics
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Ventricular tachycardia Ventricular tachycardia
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Management, Management,
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Torsade de pointes Torsade de pointes
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Supraventricular tachycardia with aberrant conduction Supraventricular tachycardia with aberrant conduction
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Ventricular fibrillation Ventricular fibrillation
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Disturbances of conduction (heart block) Disturbances of conduction (heart block)
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First-degree block First-degree block
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Second-degree block—Mobitz type I (Wenckebach) Second-degree block—Mobitz type I (Wenckebach)
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Second-degree block—Mobitz type II Second-degree block—Mobitz type II
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Third-degree block/complete heart block Third-degree block/complete heart block
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Bundle branch block Bundle branch block
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Right bundle branch block Right bundle branch block
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Left bundle branch block Left bundle branch block
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Bifascicular block Bifascicular block
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Trifascicular block Trifascicular block
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Intraoperative heart block Intraoperative heart block
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Pacemakers and defibrillators Pacemakers and defibrillators
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Implications for anaesthesia and surgery Implications for anaesthesia and surgery
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Implantable cardioverter–defibrillators Implantable cardioverter–defibrillators
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Further reading Further reading
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References References
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Further reading Further reading
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References References
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Cite
Abstract
This chapter describes the anaesthetic management of the patient with cardiovascular disease. The topics include ischaemic heart disease (including perioperative myocardial infarction and percutaneous coronary intervention), valvular heart disease (incuding prosthetic valves), congenital heart disease, cardiomyopathy, pericardial disease, the patient with a transplanted heart, narrow complex arrhythmias, broad complex arrhythmias and heart block. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described including peri-operative management of pre-existing arrhythmias (such as atrial fibrillation), and the patient with an implanted pacemaker or defibrillator.
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