[Surgical cardiac risk in patients with heart diseases. II. Perioperative treatment].

An improvement can be obtained in the surgical prognosis of the cardiopathic by working on the main risk factors. Congestive decompensation must usually be treated with diuretics; digitalis in only indicated in certain cases. In patients with ischaemic cardiopathy, angina therapy should be continued during the perioperative period, replacing the oral route; in the postoperative period. ECG monitoring is advisable up to Day III-V. Valve defects should be assessed carefully, including haemodynamically (especially severe aortic stenosis) because correction of the defect may become a priority. In hypertrophic cardiomyopathy hypovolaemia and loss of sinus rhythm should be avoided. Valve prostheses involve particular problems represented by antibacterial prophylaxis and perioperative anti-coagulation. Congenital cyanogenic cardiopathies often require a lowering of the haematocrit and careful control of hypotension. Postoperative arrhythmias generally have medical causes and require control of the latter before possible antiarrhythmic therapy. The implantation of a temporary prophylactic pacemaker is rarely needed; for patients with definitive pacemakers, some precautions are needed for the use of the thermocautery. It is very important to deal with poor general medical conditions that might affect prognosis. Control of hypertension is less important than control of hypotension.