Cardiovascular
Heart Failure in the Surgical ICU
Acute heart failure in the SICU: classification (reduced vs. preserved EF, left vs. right vs. biventricular), and treatment strategies for left and right heart failure and cardiogenic shock.
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In the surgical intensive care setting, one primarily deals with acute forms of cardiac failure.
Classification
Dimension • Types • Ejection fractionSection
Classification
Dimension • Types • Ejection fraction| Dimension | Types |
|---|---|
| Ejection fraction | Reduced EF (systolic) vs. Preserved EF (diastolic) |
| Laterality | Right-sided, Left-sided, Biventricular |
| Phase | Systolic vs. Diastolic |
| Onset | Acute vs. Chronic |
Treatment Strategies
Reduce afterload: vasodilators + diuretics • Augment inotropy: inotropic agentsSection
Treatment Strategies
Reduce afterload: vasodilators + diuretics • Augment inotropy: inotropic agentsAcute Left Heart Failure
- Reduce afterload: vasodilators + diuretics
- Augment inotropy: inotropic agents
Right Heart Failure
- Volume replacement → target PAWP ~20 mmHg
- Then inotropic support if needed
- Avoid right ventricular over-distension (causes septal shift → impairs LV filling)
RHF with AV Dissociation / Heart Block
- Sequential AV pacing
- Avoid ventricular pacing alone
Cardiogenic Shock
- Mechanical support: intra-aortic balloon pump
Key Principle
Treatment is tailored to the specific type and underlying cause of cardiac dysfunction.Section
Key Principle
Treatment is tailored to the specific type and underlying cause of cardiac dysfunction.Treatment is tailored to the specific type and underlying cause of cardiac dysfunction.
- Adapted from SurgCritCare. org for structured display and mobile use. Verify against current institutional policies and attending guidance.*