Anesthesia Considerations 

Cardiomyopathies

 

 

Considerations

 

• ↑ risk of perioperative hemodynamic compromise:

  • CHF, dysrhythmias, emboli, myocardial ischemia

• Type, etiology & severity of cardiomyopathy:

  • Dilated, restrictive, hypertrophic, peripartum

  • Presence of CHF including EF, NYHA class

  • Assess volume status & sympathetic activation

• Hemodynamic goals specific to type of cardiomyopathy:

  • Restrictive (diastolic failure): 

    • Goals: fast, full & tight (as per tamponade)

      • Contractility: maintain

      • Rate & rhythm: sinus (atrial kick important), avoid bradycardia (SV relatively fixed)

      • Afterload: maintain (coronary perfusion with ↑ LVEDP)

      • Preload: maintain normovolemia (but avoid ↑ LVEDP)

  • Dilated (systolic failure):

    • Contractility: Maintain

    • Rate & rhythm: NSR

    • Afterload: maintain, may benefit from ↓

    • Preload: normal HR, avoid ↑ afterload

  • HOCM:

    • Contractility: ↓

    • Rate & rhythm: strict NSR, avoid tachycardia

    • Afterload: maintain

    • Preload: full

• AICD/pacemaker considerations if applicable

• Comorbid disease including possible systemic implications of etiology (eg. infiltrative disease)

• Medication management: beta blockers, ACEI, anticoagulation, diuretics

 

 

 

Etiologies

 

• Dilated cardiomyopathy:

  • Idiopathic (50%)

  • Ischemic (7%)

  • Valvular

  • Viral

  • Alcoholic

  • Toxic (eg. cocaine, chemo, radiation)

  • Familial 

  • Peripartum

  • Other: SLE, ESRD, hyperthyroidism, Duchenne's

• Hypertrophic cardiomyopathy:

  • HOCM

  • Hypertensive cardiomyopathy

  • Valve lesion (e.g. AS)

• Restrictive cardiomyopathy:

  • Amyloidosis

  • Hemochromatosis

  • Sarcoidosis

  • Scleroderma

  • Radiation-induced

  • Idiopathic