Anaesthetic Management of a Patient with Dilated Cardiomyopathy and Acute Decompensated Heart Failure

Abstract

Dilated Cardiomyopathy (DCM) is a non ischaemic heart muscle disease with left or biventricular dilatation and systolic dysfunction in the absence of other heart diseases. DCM can lead to substantial morbidity and mortality due to complications like heart failure and arrhythmias. Intraoperative management of a patient with acute decompensated heart failure due to DCM is a challenge for anaesthesiologists. This case report is about a 58-year-old male patient, who was a known case of DCM with low left ventricular ejection fraction (10-15%), Chronic Kidney Disease (CKD), chronic pancreatitis, and hypertension. He came to the Emergency Department with acute decompensated heart failure and subacute intestinal obstruction. After initial stabilisation, he was scheduled to undergo emergency exploratory laparotomy for obstruction. Intraoperative management of the patient was done successfully by ensuring normovolaemia, avoiding ventricular afterload, avoiding myocardial depression and providing adequate pain relief through multimodal analgesia. The article mentions various anaesthetic concerns, risks involved and preparations required in such a case.

Keywords

• anaesthetic concerns
• intestinal obstruction
• systolic dysfunction