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BJA Advance Access published online on April 28, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem098
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 BJA: June 2007
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Diastolic heart failure in anaesthesia and critical care

R. Pirracchio1, B. Cholley1, S. De Hert3, A. Cohen Solal2 and A. Mebazaa1,*

1 Departments of Anaesthesiology and Critical Care
2 Cardiology, Lariboisière University Hospital, University Paris VII, Paris, France
3 Department of Anaesthesiology, University Hospital Antwerp, Edegem, Belgium

* Corresponding author: Département d'anesthésie-réanimation, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France. E-mail: alexandre.mebazaa{at}lrb.aphp.fr

Diastolic heart failure is an underestimated pathology with a high risk of acute decompensation during the perioperative period. This article reviews the epidemiology, risk factors, pathophysiology, and treatment of diastolic heart failure. Although frequently underestimated, diastolic heart failure is a common pathology. Diastolic heart failure involves heart failure with preserved left ventricular (LV) function, and LV diastolic dysfunction may account for acute heart failure occurring in critical care situations. Hypertensive crisis, sepsis, and myocardial ischaemia are frequently associated with acute diastolic heart failure. Symptomatic treatment focuses on the reduction in pulmonary congestion and the improvement in LV filling. Specific treatment is actually lacking, but encouraging data are emerging concerning the use of renin–angiotensin–aldosterone axis blockers, nitric oxide donors, or, very recently, new agents specifically targeting actin–myosin cross-bridges.

Keywords: assessment, preanaesthetic; complications, hypertension; complications, pulmonary oedema; heart, inodilators; heart, myocardial function


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Re: Diastolic dysfunction and heart failure
Ritesh Maharaj
British Journal of Anaesthesia, 25 Jun 2007 [Full text]
Implications of right ventricular involvement in diastolic heart failure
Justin A Woods, et al.
British Journal of Anaesthesia, 13 Sep 2007 [Full text]

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