New dilated cardiomyopathy, lap chole

46-year-old for consideration of laparoscopic cholecystectomy

Background

  • Chronic pain – ankle injury at work. In Cam Boot since November 2021. Awaiting chronic pain specialist input
  • Complex PTSD
  • Difficult social circumstances/isolation

Issues:

  • 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.

Discussion

  • 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.

Plan:

  • Await cardiologist review
  • Aim for surgery with 3 months.

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