Middle East Heart Congress March 18-20, 2019 Barcelona, Spain

Taha is an Intensivist in the Cardiac and Transplant Unit at the Institute of Critical Care Medicine; Sheikh Khalifa Medical City. Graduated from Ain Shams University in 1993 and trained in the intensive Care Unit of Adult Cardiothoracic Surgery at Ain Shams University Hospital from 1996 to 2003. During this time he received a Master’s Degree in Cardiology from Ain Shams University. He also attended special training on Echocardiography and Critical Care Ultrasound in Ain Shams University. He then received his second Masters Degree in Intensive Care Science from Ain Shams University. He was awarded a Diploma by the Royal Collage of Physician of the United Kingdom (MRCP UK) and was nominated fellowship of the American College Of Chest Physician (FCCP) in 2007. He also received the European Diploma of Intensive Care Medicine (EDIC) from Brussels, Belgium in 2008. He was awarded fellowship by the Royal Collage of Physician of Edinburgh and London (FRCP) in 2013. He is currently a Course Director and Committee member at the Society of Critical Care Medicine (SCCM) for the Fundamental Critical Care Support Course (FCCS) and the Pediatric Fundamental Critical Care Support Course (PFCCS) and Fellow of the American collage of Critical care Medicine (FCCM). He is also a director of critical care Ultrasound Courses (SCCM), MCCRC - SCCM and ESICM/BASIC Intensive Care Courses at Abu Dhabi. He conducted researches in critical care ultrasound, congenital heart diseases, surgical airway, mechanical ventilation, ICU logistics and hemodynamics. Dr. Taha served as an author in critical care chapters (Scientifi c American Critical Care, evidence-based web clinical resource Uptodate, Springer..) . He is also a member of numerous committees and international societies and chair in acute cardiac care working group ECS, he shared as a speaker and faculty in multiple national and international meetings and conferences.

Circulatory shock is common in the ICU, approximately one- third of patients admitted to ICU have circulatory shock. Septic shock is the most common presentation followed by cardiogenic , hypovolemic and infrequently obstructive shock. Most reports of cardiogenic shock pertain to patients with acute myocardial infarction. Reported in-hospital mortality aft er cardiogenic shock form acute coronary syndrome is close to 60%. Identifying and classifying circulatory shock continues to be crucial in managing patients with shock. Monitoring hemodynamics, fl uid responsiveness, cardiac output, and lactate levels in order to guide fl uid therapy and the use of vasoactive drugs is the basis of managing circulatory shock. Th e microcirculatory profi le in circulatory shock is able to diff erentiate between survivors and non survivors when hemodynamic data failed to do so. Th e objective of managing and treating shock is to maintain tissue and organ perfusion by using fl uids, vasopressors, inotropes and sometimes vasodilators. However, choosing one or a combination of interventions is not always straightforward. Fluid administration is oft en the fi rst line of defense for hypotension in shock, with the underlying assumption of decreased preload. Although fl uid administration is appropriate in early stages of most types of shock, guidance is required as positive fl uid balance accumulates. Fluid accumulation that redistributes to the interstitial tissues rather than remaining in the intravascular space may increase the required perfusion pressure by increasing resistance through elevated tissue or organ pressure. Cardiac function can be best monitored by echocardiography, which aids in characterizing the nature of shock, selecting the appropriate intervention, and evaluating the patient's response to the intervention. For most intensivists, echocardiography is relatively easy to learn and perform at the bedside. Visual evaluation enables relatively precise estimation of the ejection fraction and left ventricular fi lling pressures. Echocardiography also provides dynamic variables for estimation of fl uid responsiveness and right ventricular function.

Yasser Zaghloul is a Consultant of Anesthesia at Sheikh Khalifa Medical City, Abu Dhabi, UAE. He is the Director of Abu Dhabi Anesthesia Club and Anesthesia Refresher Course and also Lecturer and Instructor in the following international courses: FCCS, PFCCS, ENLS, airway management, critical care nephrology and mechanical ventilation courses. He had previously worked as a Consultant of Anesthesia & ICU in Ireland. He has completed graduation in 1986 from Faculty of Medicine, Alexandria University, Egypt. He has been trained in anesthesia and critical care medicine in both Egypt and Ireland. He has extensive experience and interest in neuro-anethesia and neurocritical care, neonatal and pediatric anesthesia and perioperative medicine. He has delivered more than 160 lectures in international anesthesia, pain and ICU conferences.

The prevalence of Heart Failure (HF) in the general population continues to grow. Meanwhile, the risk of perioperative HF increases with major surgery, elderly patients, vascular surgery and in the presence of a systemic disease. Th is makes HF one of the most common conditions requiring evaluation and treatment in the perioperative period. HF is considered a major risk factor for development of postoperative cardiac complications e.g. ischemia, infarction and cardiac death. Moreover, some patients may develop HF without structure heart disease like in cases of hypertension, diabetes mellitus, obesity, metabolic syndrome and sepsis. HF is associated with signifi cant neurohormonal changes and activation of sympathetic nervous system. In addition to the systemic perioperative changes e.g. stress response, blood loss and hypoxaemia, all result in increase in the complexity of the patho-physiology and management. Th ere are many causes which contribute in the pathogenesis of HF e.g. impaired contractility, systolic and or diastolic dysfunction, obstructive and regurgitated vavular disease, rate and rhythm abnormalities and pulmonary diseases. In the perioperative sitting, HF should be diff erentiated from other causes of pulmonary edema which may occur in patients without cardiac problems e.g. fl uid overload and neurogenic pulmonary edema. In patients with chronic HF, perioperative and anesthetic management should focus on prevention and treatment of factors which may precipitate acute de-compensation e.g. discontinuation of therapy, sympathetic activity, myocardial ischemia, anemia, volume overload, arrhythmias and poor pain management. Patients with diagnosed HF should continue their cardiac medications during the perioperative period. Th ese include anti-hypertensive, ant-ischemic, anti-arrhythmic and ant-failure medications. In conclusion, HF is an important predictor of adverse outcome; it increases the risk of operative mortality and hospital readmission. Improvements in perioperative care are needed to minimize the risk of heart failure and its consequences.