Cardiomyopathy, Ischemic

Approximately a 1:1000 incidence per y, increasing with age.

M:F incidence ratio: 2:1.

Most common cause of heart failure; accounts for 40% of all cases.

CHF exacerbation

Hypotension

Pulmonary edema

Myocardial ischemia/infarction

Acute renal failure

Malignant arrhythmias/pacemaker management with electrocautery

LVEF, which is important for prognosis and periop complications but may not correlate with symptoms or exercise tolerance

Acute heart failure (hypoventilation → hypercarbia → increased PVR → right heart failure)

Inability to extubate (cardiac instability, pulmonary edema)

Periop cardiac event (MI)

Fluid management (balance optimizing preload with volume overload, minimizing fluid shifts)

High risk for arrhythmia (PAC, PVC, AFIB, Vtach, VFIB)

Postop ICU care (CCU versus SICU [severity of heart disease versus magnitude of surgery])

Severe impairment of LVEF leading to CHF; instances arising from myocardial ischemia and infarction have extremely poor prognoses, with a 30–50% 2-y mortality.

Pts will benefit from optimization of medical therapy for underlying ischemia (nitrates, beta-blockers, calcium antagonists, aspirin), CHF (ACE inhibitors/angiotensin-II receptor blockers, hydralazine, digoxin, aldosterone antagonists, loop diuretics), prevention of cardiac thrombus formation (warfarin), and HR control for atrial fibrillation (digoxin, beta-blockers).

An ICD for secondary prevention of SCD is likely. A mortality benefit exists, especially if LVEF <35%.

CRT with biventricular pacing improves symptoms in pts with prolonged QRS duration with low LVEF.

Acquired disease with genetic predisposition.

Risk factors include hypertension, diabetes, hyperlipidemia, tobacco, advanced age, obesity, and peripheral vascular disease.