46-year-old for consideration of laparoscopic cholecystectomy
- Chronic pain – ankle injury at work. In Cam Boot since November 2021. Awaiting chronic pain specialist input
- Complex PTSD
- Difficult social circumstances/isolation
- HFREF – New diagnosis in January 2022
- Dilated cardiomyopathy, EF 37%. Moderate functional MR
- Admission with decompensated heart failure post-covid infection.
- Alcohol-related, drinking 2 litres of wine per day
- Commenced on optimal medical management: bisoprolol, Entresto (Sacubitril/Valsartan), spironolactone and furosemide. See figure below.
- Symptoms stable – no orthopnoea/PND. Mild pitting ankle oedema.
- DASI – 5 Met’s
Pharmacological management of HFrEF
MRA – mineralocorticoid antagonist. ARNI – angiotensin-receptor neprilysin inhibitor
- Cholelithiasis – recurrent biliary colic. No admissions or cholecystitis.
- Alcohol abuse – abstinent since January but currently struggling with this.
- Cardiology meeting discussion with repeat echocardiogram
- Some improvement in echo but not as much as expected 3 months post-event.
- LV now mildly dilated, LVSF unchanged/slightly improved. MR mild.
- Outpatient review with cardiologist required preoperatively
- Ensure euvolemia and careful cardiac monitoring perioperatively
- NT proBNP = 298. Borderline, suggestive of increased perioperative risk and therefore aids in decision-making with regards to perioperative monitoring and level of postoperative care.
- Alcohol abuse
- Multiple significant contributors
- Discussed options for support, patient keen to engage.
- Await cardiologist review
- Aim for surgery with 3 months.