Falla cardiaca con fracción de eyección preservada: generalidades y aproximación en el perioperatorio

Resumen

La falla cardiaca con fracción de eyección preservada es frecuente y de difícil abordaje perioperatorio en población adulta. Es un síndrome clínico complejo con alteraciones estructurales y funcionales cardiacas con fracción de eyección del ventrículo izquierdo preservada (FEVI) > 50 %. Los biomarcadores, la ecocardiografía, el cateterismo cardiaco y otros métodos no invasivos confirman el diagnóstico. Actualmente no existe manejo específico efectivo comparado al de la falla con fevi reducida. Objetivo: elaborar una revisión de la literatura sobre la falla cardiaca con fracción de eyección preservada y sus implicaciones anestésicas. Métodos: se realizó una revisión no sistemática de la literatura en las siguientes bases de datos: Pubmed/Medline, LILACS, ScienceDirect. Resultados: la falla cardiaca con fracción de eyección preservada es una entidad común con una prevalencia entre 36,9 % y más del 50 % del total de pacientes. La fisiopatología incluye alteraciones diastólicas del ciclo cardiaco incluyendo las fases de relajación y de compliance ventricular. Desde el punto de vista anestésico se debe mantener el ritmo sinusal en arritmias, controlar la respuesta cronotrópica, evitar congestión pulmonar, manejar específicamente las etiologías-comorbilidades, conservar presiones de llenado ventricular y lograr estabilidad hemodinámica. Conclusión: los pacientes con este síndrome representan un reto anestésico. El manejo incluye tratamiento específico de las etiologías, comorbilidades y fenotipos. A diferencia de la falla cardiaca con fracción de eyección reducida, no existen terapias que disminuyan la mortalidad, por lo que se requieren nuevos fármacos y estudios clínicos que mejoren las perspectivas anestésicas y el abordaje terapéutico.

Biografía del autor/a

Nelson Adolfo López Garzón, Universidad del Cauca

MD, Especialista en Medicina Interna y Cardiología, Candidato a Doctorado en Educación. Departamento de Medicina Interna, Profesor titular Facultad Ciencias de la Salud Universidad del Cauca. Popayán, Colombia.

Gustavo Adolfo Ángel, Universidad del Cauca

MD, Residente Posgrado de Anestesiología, Departamento de Anestesiología, Hospital Universitario San José Universidad del Cauca, Popayán, Colombia.

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Biografía del autor/a

Nelson Adolfo López Garzón, Universidad del Cauca

MD, Especialista en Medicina Interna y Cardiología, Candidato a Doctorado en Educación. Departamento de Medicina Interna, Profesor titular Facultad Ciencias de la Salud Universidad del Cauca. Popayán, Colombia.

Gustavo Adolfo Ángel, Universidad del Cauca

MD, Residente Posgrado de Anestesiología, Departamento de Anestesiología, Hospital Universitario San José Universidad del Cauca, Popayán, Colombia.

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Cómo citar
López Garzón, N. A., & Ángel, G. A. (2021). Falla cardiaca con fracción de eyección preservada: generalidades y aproximación en el perioperatorio. Revista Med, 28(2), 49-60. https://doi.org/10.18359/rmed.4854
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2021-06-04
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