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Diastolic Dysfunction Perioperative — FRCA Final MCQ

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ModeratePreoperative AssessmentDiastolic Dysfunction PerioperativeFRCA Final

A 65-year-old man (ASA III) has a pre-operative transthoracic echocardiogram showing an ejection fraction of 55%, grade 2 diastolic dysfunction (E/A ratio 0.8, elevated E/e'), and an estimated RVSP of 30 mmHg. What is the clinical significance of the diastolic dysfunction?

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Correct answer: E — Requires urgent cardiology review before any surgery

Grade 2 (moderate) diastolic dysfunction with a preserved ejection fraction (heart failure with preserved EF, HFpEF) is clinically significant perioperatively. These patients have a stiff, non-compliant ventricle that is highly dependent on atrial contraction for filling. They are: (1) sensitive to fluid overload (small volume increases cause pulmonary oedema), (2) dependent on sinus rhythm (AF causes significant decompensation), (3) reliant on adequate preload (hypovolaemia also poorly tolerated), and (4) at risk of perioperative heart failure. Goal-directed fluid therapy with small, titrated boluses is recommended.

Reference: ESC – 2021 – Heart failure guidelines; RCOA – 2023 – Preoperative cardiac assessment