Heart failure diastolic

Yu CM, Sanderson JE. Update in the management of diastolic heart failure. Curr Vase Pharmacol 2004 2(3) 301-8. 

Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB, Kitzman DW et al. Effects of digoxin on morbidity and mortality in diastolic heart failure the ancillary digitalis investigation group trial. Circulation 2006 114(5) 397-403. 

Aronow WS Drug treatment of systolic and diastolic heart failure in elderly persons. J Gerontol A Biol Med Sci 2005 60 1597. [PMID 16424295]... 

Likewise, heart failure is not always associated with systolic dysfunction and an obvious decline in cardiac pumping ability. In approximately half the cases of symptomatic heart failure, systolic function and cardiac output may appear normal when the patient is at rest.53,63 In this type of heart failure, cardiac function is impaired because the left ventricle is stiff and unable to relax during the filling phase, resulting in increased pressures at the end of diastole.31 This condition is often described as diastolic heart failure, but it is also identified by other names such as heart failure with preserved left ventricular... 

Gutierrez C, Blanchard DG. Diastolic heart failure challenges of diagnosis and treatment. Am Fam Physician. 2004 69 2609-2616. 

Sanderson JE. Diastolic heart failure or heart failure with a normal ejection fraction. Minerva Cardioangiol 2006 54 715-724. 

Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure Part I diagnosis, prognosis, and measurements of diastolic function. Circulation 2002 105 1387-1393. 

Aurigemma GR Gaasch WH. Clinical practice. Diastolic heart failure. N Engl J Med 2004 351 1097-1 105. 

Myocardial hypertrophy The heart increases in size, and the chambers dilate. Initially, stretching of the heart muscle leads to a stronger contraction of the heart. However, excessive elongation of the fibers results in weaker contractions. This type of failure is termed systolic failure and is a result of a ventricle unable to pump effectively. Less commonly, patients with CHF may have diastolic dysfunction—a term applied when the ventricles ability to relax and accept blood is impaired by structural changes, such as hypertrophy. The thickening of the ventricular wall and subsequent decrease in ventricular volume decreases the ability of heart muscle to relax. In this case, the ventricle does not fill adequately, and the inadequacy of cardiac output is termed diastolic heart failure. 

Wheeldon NM, Clarkson P, MacDonald TM. Diastolic heart failure. Eur Heart J 1994 15(12) 1689-97. 

Heart failure can result from any disorder that affects the ability of the heart to contract (systolic function) and/or relax (diastolic dysfunction) common causes of heart failure are shown in Table 14—1 Systolic heart failure is the classic, more familiar form of the disorder, but current estimates suggest that 20% to 50% of patients with heart failure have preserved left ventricular systolic function and suffer from diastolic dysfunction. In contrast to systolic heart failure that is usually caused by previous myocardial infarction (Ml), patients with diastolic heart failure typically are elderly, female, and have hypertension and diabetes. However, systolic and diastolic dysfunction frequently coexist. The common cardiovascular diseases such as MI and hypertension can cause both systolic and diastolic dysfunction thus many patients have heart failure as a result of reduced myocardial contractility and abnormal ventricular filling. 

The diagnosis of diastolic heart failure can be made when a patient has (1) both symptoms and signs on physical examination of congestive heartfailure and (2) preserved left ventricular (LV) function. 

Treatment should be targeted at symptom reduction, causal clinical disease, and underlying basic mechanisms. Patients with diastolic heart failure may be treated differently than those with systolic dysfunction. 

Heart failure (HP) may becausedbya primary abnormality in systolic function, diastolic function, or both. Making the distinction is important because the prevalence, prognosis, and treatment of HP may be quite different depending on whether the predominant mechanism causing the symptoms is systolic or diastolic dysfunction. Some clinical studies have reported that as many as 30% to 50% of patients with congestive heart failure have preserved left ventricular (LV) function, making diastolic heart failure (DHP) very common. In addition, abnormalities in diastolic function also can play an important role in the development of symptoms in patients with cardiomyopathy and systolic heart failure (SHP). 

TABLE 18—1. Potential Pathologic Mechanisms of Diastolic Heart Failure... 

FIGURE 18-2. Treatmentof acute decompensated diastolic heart failure. 

FIGURE 18-3. Treatment of chronic diastolic heart failure. 

Zile MR. Heart failure with preserved ejection fraction Is this diastolic heart failure 1 Am Coll Cardiol 2003 41 1519—1522. 

Mandinov L, Eberli FR, Seiler C, Hess OM. Diastolic heart failure. Car-diovasc Res 2000 45 813-825. 

European Study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. Fur Heart J 1998 19 990-1003. 

Vasan RS, Levy D. Defining diastolic heart failure A call for standardized diagnostic criteria. Circulation 2000 101 2118-2121. 

Kitzman DW, Little WC, Brubaker PH, et al. Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. JAMA 2002 288 2144-2150. 

Zile MR Diastolic heart failure Diagnosis, prognosis, treatment. Minerva Cardiol 2003 51 131-142. 

Gaasch WH, Zile MR. Left ventricular diastolic dysfunction and diastolic heart failure. Ann Rev Med 2004 55 373-394. 

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