ABSTRACT
INTRODUCTION All diseases of the heart can evolve towards the stage of heart failure (HF). HF develops either insidiously or suddenly and encompasses a wide spectrum of clinical conditions, ranging from asymptomatic cardiac lesions to life-threatening pulmonary edema or cardiogenic shock. Heart disease can progress from asymptomatic to symptomatic, from gradual or acute decompensation to recompensation, and eventually to terminal or end-stage failure. However, the chance of an event-free survival varies considerably, depending on the nature of the disease. The etiology of heart disease has changed greatly in the course of last century; in Europe, at the beginning of twentieth century, rheumatic and infectious etiologies were responsible for 70% of all heart diseases (1). Today, coronary artery disease is not only responsible for 80% of all cardiac deaths, but also for most cases of HF (2,3). The prevalence of HF increases dramatically with increasing age. Because of prolonged life spans and efficacious therapies for coronary artery disease, the absolute numbers of people with HF in the community is increasing. Consequently, more patients suffering from HF are admitted to hospital and require anesthesia and surgery. In the past, anesthesiologists caring for patients with coronary artery disease focused mainly on perioperative myocardial ischemia and learned how to recognize, treat, and prevent it. Now anesthesiologists may meet patients who survived their infarctions and episodes of ischemia. When these patients present for surgery, they are carrying a new major risk, that of a failing heart.
