Top Tweets for #lowEF

4 months ago

❤️‍🩹 𝐋𝐎𝐖 𝐄𝐅, 𝐍𝐨 𝐆𝐔𝐄𝐒𝐒𝐖𝐎𝐑𝐊 : 𝐒𝐌𝐀𝐑𝐓 𝐏𝐄𝐑𝐈𝐎𝐏𝐄𝐑𝐀𝐓𝐈𝐕𝐄 𝐏𝐄𝐀𝐑𝐋𝐒❤️‍🩹 #LowEF #HeartFailure #PerioperativeMedicine #Anesthesia #GeriatricAnesthesia #RegionalAnesthesia #NeuraxialAnesthesia #GeneralAnesthesia #GrayZonesInRA #GrayAreasInRA 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀: Managing patients with low EF is all about preventing sudden swings. They are, PRELOAD sensitive, AFTERLOAD vulnerable, RHYTHM dependent, HYPOXIA intolerant, ANEMIA intolerant, and FLUID-OVERLOAD intolerant. 1️⃣ 🧭 𝐏𝐑𝐄𝐎𝐏: 𝐊𝐍𝐎𝐖𝐈𝐍𝐆 𝐓𝐇𝐄 𝐇𝐄𝐀𝐑𝐓 🔹 EF is only a number - assess physiology 🔹 Look for red flags: dyspnea, edema, orthopnea, tachycardia 🔹 Postpone elective surgery if HF is decompensated 🔹 Continue chronic beta-blockers 🔹 Stop SGLT2 inhibitors 3–4 days before surgery 🔹 Individualize ACEI/ARB/ARNI & diuretics 🔹 Plan anticoagulation & antiplatelet strategy early 2️⃣💧 𝐅𝐋𝐔𝐈��𝐒: 𝐓𝐈𝐍𝐘 𝐁𝐎𝐋𝐔𝐒, 𝐓𝐈𝐆𝐇𝐓 𝐑𝐄𝐀𝐒𝐒𝐄𝐒𝐒𝐌𝐄𝐍𝐓 🔹 Avoid blind fluid loading 🔹 Give 100–150 mL bolus, then reassess 🔹 Replace loss, not fear 🔹 Use POCUS when unsure 🔹 Start vasopressor early if vasodilated 🔹 Avoid both underfilling & overload 3️⃣🩸 𝐁𝐋𝐎𝐎𝐃: 𝐏𝐑𝐎𝐓𝐄𝐂𝐓 𝐎𝐗𝐘𝐆𝐄𝐍, 𝐀𝐕𝐎𝐈𝐃 𝐎𝐕𝐄𝐑𝐋𝐎𝐀𝐃 🔹 Correct anemia preoperatively 🔹 Do not transfuse by Hb alone 🔹 Transfuse one unit at a time 🔹 Reassess after each unit 🔹 Prevent bleeding: TXA, cell salvage, warming, calcium, TEG/ROTEM when available 4️⃣💉 𝐏𝐑𝐄𝐒𝐒𝐎𝐑𝐒 & 𝐈𝐍𝐎𝐓𝐑𝐎𝐏𝐈𝐂: 𝐓𝐑𝐄𝐀𝐓 𝐓𝐇𝐄 𝐌𝐄𝐂𝐇𝐀𝐍𝐈𝐒𝐌 🔹 Norepinephrine: vasodilated hypotension 🔹 Dobutamine: low output, poor contractility 🔹 Milrinone: LV dysfunction with PH/RV strain 🔹 Vasopressin: catecholamine-resistant vasoplegia 🔹 Phenylephrine: use cautiously (may increase afterload) 🔹 Epinephrine: rescue for severe myocardial depression 5️⃣🫀 𝐓𝐀𝐑𝐆𝐄𝐓𝐒: 𝐒𝐋𝐎𝐖 𝐇𝐄𝐀𝐑𝐓, 𝐅𝐔𝐋𝐋 𝐂𝐎𝐑𝐎𝐍𝐀𝐑𝐈𝐄𝐒, 𝐃𝐑𝐘 𝐋𝐔𝐍𝐆𝐒 🔹 Avoid hypotension 🔹 Avoid tachycardia 🔹 Avoid severe bradycardia 🔹 Maintain sinus rhythm 🔹 Avoid sudden afterload drop 🔹 Avoid sudden afterload rise 🔹 Maintain oxygenation and coronary perfusion 6️⃣🫁 𝐆𝐀: 𝐒𝐌𝐎𝐎𝐓𝐇 𝐈𝐍, 𝐒𝐌𝐎𝐎𝐓𝐇 𝐎𝐔𝐓 🔹 Induce slowly 🔹 Titrate small doses 🔹 Avoid deep volatile anesthesia 🔹 Ventilate gently 🔹 Avoid hypoxia, hypercarbia, acidosis, high PEEP 🔹 Extubate smoothly 🔹 Plan HDU/ICU when risk is high 7️⃣🦴 𝐍𝐄𝐔𝐑𝐀𝐗𝐈𝐀𝐋: 𝐂𝐎𝐍𝐓𝐑𝐎𝐋𝐋𝐄𝐃 𝐒𝐘𝐌𝐏𝐀𝐓𝐇𝐄𝐂𝐓𝐎𝐌𝐘 🔹 Not automatically safer than GA 🔹 Avoid dense high spinal 🔹 Prefer low-dose spinal when suitable 🔹 Titrate epidural/CSE slowly 🔹 Keep pressors ready 🔹 Use peripheral nerve blocks as allies 🔹 Choose the technique with least hemodynamic swing 8️⃣👴 𝐆𝐄𝐑𝐈𝐀𝐓𝐑𝐈𝐂 𝐋𝐎𝐖 𝐄𝐅: 𝐒𝐌𝐀𝐋𝐋 𝐃𝐎𝐒𝐄, 𝐁𝐈𝐆 𝐂𝐎𝐍𝐒𝐄𝐐𝐔𝐄𝐍𝐂𝐄𝐒 🔹 Start low, go slow 🔹 Avoid delirium triggers 🔹 Protect kidneys 🔹 Avoid oversedation 🔹 Mobilize early 🔹 Use multimodal analgesia 9️⃣ 🖥️ 𝐌𝐎𝐍𝐈𝐓𝐎𝐑𝐈𝐍𝐆: 𝐒𝐄𝐄 𝐄𝐀𝐑𝐋𝐘, 𝐀𝐂𝐓 𝐄𝐀𝐑𝐋𝐘 🔹 Arterial line 🔹 POCUS early 🔹 Do not rely on CVP alone 🔹 Watch urine output, lactate, perfusion, temperature 🔹 Monitor postoperative troponin in high-risk patients 🔹 Decide postoperative destination before induction 🔟 🚨 𝐇𝐘𝐏𝐎𝐓𝐄𝐍𝐒𝐈𝐎𝐍 𝐀𝐋𝐆𝐎𝐑𝐈𝐓𝐇𝐌 🔹 Pause and check 🔹 Classify the phenotype 🔹 Correct the cause 🔹 Reassess and repeat 🔹 Use echo early 🔹 Don’t treat every low BP with fluid 1️⃣1️⃣🔥 𝐏𝐎𝐒𝐓𝐎𝐏: 𝐕𝐈𝐆𝐈𝐋𝐀𝐍𝐂𝐄 𝐃𝐎𝐄𝐒𝐍’𝐓 𝐄𝐍𝐃 𝐀𝐓 𝐒𝐊𝐈𝐍 𝐂𝐋𝐎𝐒𝐔𝐑𝐄 🔹 Control pain 🔹 Prevent shivering 🔹 Avoid hypoxia 🔹 Watch fluid creep 🔹 Restart HF drugs when stable 🔹 Look for arrhythmia, ischemia, AKI, delirium 🎯 𝐊𝐄𝐘 𝐓𝐀𝐊𝐄𝐀𝐖𝐀��𝐒 🔹 In low EF patients, the safest anesthesia is not GA or Neuraxials. 🔹 It is the technique that produces the least hemodynamic swing. 𝐋𝐨𝐰 𝐄𝐅 = 𝐋𝐨𝐰 𝐌𝐚𝐫𝐠𝐢𝐧 ✅ Plan ahead. Optimize. Monitor closely. Treat early. Team approach. Safe outcomes.

KartikBSonawane's tweet photo. ❤️‍🩹 𝐋𝐎𝐖 𝐄𝐅, 𝐍𝐨 𝐆𝐔𝐄𝐒𝐒𝐖𝐎𝐑𝐊 : 𝐒𝐌𝐀𝐑𝐓 𝐏𝐄𝐑𝐈𝐎𝐏𝐄𝐑𝐀𝐓𝐈𝐕𝐄 𝐏𝐄𝐀𝐑𝐋𝐒❤️‍🩹

#LowEF #HeartFailure #PerioperativeMedicine #Anesthesia #GeriatricAnesthesia #RegionalAnesthesia #NeuraxialAnesthesia #GeneralAnesthesia
#GrayZonesInRA #GrayAreasInRA

𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀:

Managing patients with low EF is all about preventing sudden swings.

They are,

PRELOAD sensitive,
AFTERLOAD vulnerable,
RHYTHM dependent,
HYPOXIA intolerant,
ANEMIA intolerant, and
FLUID-OVERLOAD intolerant.

1️⃣ 🧭 𝐏𝐑𝐄𝐎𝐏: 𝐊𝐍𝐎𝐖𝐈𝐍𝐆 𝐓𝐇𝐄 𝐇𝐄𝐀𝐑𝐓

🔹 EF is only a number - assess physiology
🔹 Look for red flags: dyspnea, edema, orthopnea, tachycardia
🔹 Postpone elective surgery if HF is decompensated
🔹 Continue chronic beta-blockers
🔹 Stop SGLT2 inhibitors 3–4 days before surgery
🔹 Individualize ACEI/ARB/ARNI & diuretics
🔹 Plan anticoagulation & antiplatelet strategy early

2️⃣💧 𝐅𝐋𝐔𝐈��𝐒: 𝐓𝐈𝐍𝐘 𝐁𝐎𝐋𝐔𝐒, 𝐓𝐈𝐆𝐇𝐓 𝐑𝐄𝐀𝐒𝐒𝐄𝐒𝐒𝐌𝐄𝐍𝐓

🔹 Avoid blind fluid loading
🔹 Give 100–150 mL bolus, then reassess
🔹 Replace loss, not fear
🔹 Use POCUS when unsure
🔹 Start vasopressor early if vasodilated
🔹 Avoid both underfilling & overload

3️⃣🩸 𝐁𝐋𝐎𝐎𝐃: 𝐏𝐑𝐎𝐓𝐄𝐂𝐓 𝐎𝐗𝐘𝐆𝐄𝐍, 𝐀𝐕𝐎𝐈𝐃 𝐎𝐕𝐄𝐑𝐋𝐎𝐀𝐃

🔹 Correct anemia preoperatively
🔹 Do not transfuse by Hb alone
🔹 Transfuse one unit at a time
🔹 Reassess after each unit
🔹 Prevent bleeding: TXA, cell salvage, warming, calcium, TEG/ROTEM when available

4️⃣💉 𝐏𝐑𝐄𝐒𝐒𝐎𝐑𝐒 & 𝐈𝐍𝐎𝐓𝐑𝐎𝐏𝐈𝐂: 𝐓𝐑𝐄𝐀𝐓 𝐓𝐇𝐄 𝐌𝐄𝐂𝐇𝐀𝐍𝐈𝐒𝐌

🔹 Norepinephrine: vasodilated hypotension
🔹 Dobutamine: low output, poor contractility
🔹 Milrinone: LV dysfunction with PH/RV strain
🔹 Vasopressin: catecholamine-resistant vasoplegia
🔹 Phenylephrine: use cautiously (may increase afterload)
🔹 Epinephrine: rescue for severe myocardial depression

5️⃣🫀 𝐓𝐀𝐑𝐆𝐄𝐓𝐒: 𝐒𝐋𝐎𝐖 𝐇𝐄𝐀𝐑𝐓, 𝐅𝐔𝐋𝐋 𝐂𝐎𝐑𝐎𝐍𝐀𝐑𝐈𝐄𝐒, 𝐃𝐑𝐘 𝐋𝐔𝐍𝐆𝐒

🔹 Avoid hypotension
🔹 Avoid tachycardia
🔹 Avoid severe bradycardia
🔹 Maintain sinus rhythm
🔹 Avoid sudden afterload drop
🔹 Avoid sudden afterload rise
🔹 Maintain oxygenation and coronary perfusion

6️⃣🫁 𝐆𝐀: 𝐒𝐌𝐎𝐎𝐓𝐇 𝐈𝐍, 𝐒𝐌𝐎𝐎𝐓𝐇 𝐎𝐔𝐓

🔹 Induce slowly
🔹 Titrate small doses
🔹 Avoid deep volatile anesthesia
🔹 Ventilate gently
🔹 Avoid hypoxia, hypercarbia, acidosis, high PEEP
🔹 Extubate smoothly
🔹 Plan HDU/ICU when risk is high

7️⃣🦴 𝐍𝐄𝐔𝐑𝐀𝐗𝐈𝐀𝐋: 𝐂𝐎𝐍𝐓𝐑𝐎𝐋𝐋𝐄𝐃 𝐒𝐘𝐌𝐏𝐀𝐓𝐇𝐄𝐂𝐓𝐎𝐌𝐘

🔹 Not automatically safer than GA
🔹 Avoid dense high spinal
🔹 Prefer low-dose spinal when suitable
🔹 Titrate epidural/CSE slowly
🔹 Keep pressors ready
🔹 Use peripheral nerve blocks as allies
🔹 Choose the technique with least hemodynamic swing

8️⃣👴 𝐆𝐄𝐑𝐈𝐀𝐓𝐑𝐈𝐂 𝐋𝐎𝐖 𝐄𝐅: 𝐒𝐌𝐀𝐋𝐋 𝐃𝐎𝐒𝐄, 𝐁𝐈𝐆 𝐂𝐎𝐍𝐒𝐄𝐐𝐔𝐄𝐍𝐂𝐄𝐒

🔹 Start low, go slow
🔹 Avoid delirium triggers
🔹 Protect kidneys
🔹 Avoid oversedation
🔹 Mobilize early
🔹 Use multimodal analgesia

9️⃣ 🖥️ 𝐌𝐎𝐍𝐈𝐓𝐎𝐑𝐈𝐍𝐆: 𝐒𝐄𝐄 𝐄𝐀𝐑𝐋𝐘, 𝐀𝐂𝐓 𝐄𝐀𝐑𝐋𝐘

🔹 Arterial line
🔹 POCUS early
🔹 Do not rely on CVP alone
🔹 Watch urine output, lactate, perfusion, temperature
🔹 Monitor postoperative troponin in high-risk patients
🔹 Decide postoperative destination before induction

🔟 🚨 𝐇𝐘𝐏𝐎𝐓𝐄𝐍𝐒𝐈𝐎𝐍 𝐀𝐋𝐆𝐎𝐑𝐈𝐓𝐇𝐌

🔹 Pause and check
🔹 Classify the phenotype
🔹 Correct the cause
🔹 Reassess and repeat
🔹 Use echo early
🔹 Don’t treat every low BP with fluid

1️⃣1️⃣🔥 𝐏𝐎𝐒𝐓𝐎𝐏: 𝐕𝐈𝐆𝐈𝐋𝐀𝐍𝐂𝐄 𝐃𝐎𝐄𝐒𝐍’𝐓 𝐄𝐍𝐃 𝐀𝐓 𝐒𝐊𝐈𝐍 𝐂𝐋𝐎𝐒𝐔𝐑𝐄

🔹 Control pain
🔹 Prevent shivering
🔹 Avoid hypoxia
🔹 Watch fluid creep
🔹 Restart HF drugs when stable
🔹 Look for arrhythmia, ischemia, AKI, delirium

🎯 𝐊𝐄𝐘 𝐓𝐀𝐊𝐄𝐀𝐖𝐀��𝐒

🔹 In low EF patients, the safest anesthesia is not GA or Neuraxials.
🔹 It is the technique that produces the least hemodynamic swing.

𝐋𝐨𝐰 𝐄𝐅 = 𝐋𝐨𝐰 𝐌𝐚𝐫𝐠𝐢𝐧

✅ Plan ahead. Optimize. Monitor closely. Treat early. Team approach. Safe outcomes.

578

Maziar Khorsandi @KhorsandiMaziar

almost 4 years ago

My UW Cardiology grand rounds on low EF coronary revasc. Thank you @UWCardiology for the opportunity to give this talk! #coronaryarterydisease #CABG #LowEF @UW @UWCTSurgRes @uwashfellows @UWMedicine @UWSurgery @UWMedHeart https://t.co/x1FftgORbs

Dilmar Cunha @dilmar_cunha

over 4 years ago

52 yrs, 2 years after mitral valve replacement, complaint of shortness of breath EF 12% #CardioTwitter #echofirst #lowef

Mario Mekhael @MekhaelMario

almost 5 years ago

Intertwined relationship between LV dysfunction and Atrial Disease. Data from @makkayadr previously showed increased #AtrialFibrosis in #LowEF patients (https://t.co/gUZLugHR49). @nmarrouche #ProgressionOfDisease

MekhaelMario's tweet photo. Intertwined relationship between LV dysfunction and Atrial Disease. Data from @makkayadr previously showed increased #AtrialFibrosis in #LowEF patients (https://t.co/gUZLugHR49). @nmarrouche #ProgressionOfDisease https://t.co/91RSbRnepe

Prash Sanders

@PrashSanders

almost 5 years ago

There is a lot to do with a progressive atrial disease https://t.co/nPaBbwFe7C

Journal of Cardiac Surgery @JCardSurg

over 5 years ago

Check out this case series of #lowEF #CABG patients who received perioperative #Impella: https://t.co/CUwK05FOZQ #JOCS #JCardSurg

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