Heart failure systolic/diastolic

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... 

Unlike systolic HF, few prospective trials have evaluated the safety and efficacy of various cardiac medications in patients with diastolic HF or preserved ejection fraction. The Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) study demonstrated that angiotensin receptor blockade with candesartan resulted in beneficial effects on HF morbidity in patients with preserved LVEF similar to those seen in depressed LV function.25... 

Hypertension is the most common cardiovascular disease in fact, nearly 25% of adults in the U.S. are considered hypertensive. Hypertension is defined as a consistent elevation in blood pressure such that systolic/diastolic pressures are >140/90 mmHg. Over time, chronic hypertension can cause pathological changes in the vasculature and in the heart. As a result, hypertensive patients are at increased risk for atherosclerosis, aneurysm, stroke, myocardial infarction, heart failure, and kidney failure. There are several categories of antihypertensive agents ... 

Heart failure (HF) is a clinical syndrome caused by the inability of the heart to pump sufficient blood to meet the metabolic needs of the body. HF can result from any disorder that reduces ventricular filling (diastolic dysfunction) and/or myocardial contractility (systolic dysfunction). 

Cardiostimulation. By stimulating Pi-receptors, hence activation of ade-nylatcyclase (Ad-cyclase) and cAMP production, catecholamines augment all heart functions, including systolic force (positive inotropism), velocity of shortening (p. clinotropism), sinoatrial rate (p. chronotropism), conduction velocity (p. dromotropism), and excitability (p. bathmotropism). In pacemaker fibers, diastolic depolarization is hastened, so that the firing threshold for the action potential is reached sooner (positive chronotropic effect, B). The cardiostim-ulant effect of p-sympathomimetics such as epinephrine is exploited in the treatment of cardiac arrest Use of p-sympathomimetics in heart failure carries the risk of cardiac arrhythmias. 

Myocardial ischemia and infarction cause abnorma myocardial metabolism, decreased left ventricular (LV) systolic function, diastolic dysfunction, congestive heart failure, and decreased survival. Consequently, revascularization techniques, either surgical or catheter based, have become integral to treatment of severe ischemic heart disease. 

The management of heart failure in the presence of normal systolic function is not reviewed. This form of heart failure commonly occurs in the elderly with chronic hypertension and left ventricular hypertrophy. The failure of the left ventricle to relax during diastole (diastolic dysfunction) results in elevated end diastolic... 

The usual cause of pulmonary edema is acute left ventricular failure. The sequelae of events after left heart failure roughly follow the pattern of reduced stroke volume, leading to increased end-systolic and diastolic volume, which elevates left ventricular end-diastolic pres-... 

Congestive heart failure (CHF) is a clinical syndrome with multiple causes and involve the right or left ventricle or both and in CHF, cardiac output is usually below the normal range. This ventricular dysfunction may be systolic, which leads to inadequate force generation to eject blood normally and diastolic, which leads to inadequate relaxation to permit normal filling. Systolic dysfunction, with decreased cardiac output and significantly reduced ejection fraction is typical of acute heart failure, especially that resulting from myocardial infarction. 

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

In 40 ambulatory hemodialysis patients, 25 of whom were taking pioglitazone and 15 rosiglitazone, there were no increases in intravascular volume, anemia, edema, or chronic heart failure in a retrospective study (61). It may be that dialysis obviates any increase in intravascular volume. The use of these drugs during dialysis seems to be safe, although there were reductions in systolic and diastolic blood pressures. 

Heart failure is a progressive syndrome, and optimal pharmacologic management is based on a detailed diagnosis, determination of the etiology, characterization of the clinical syndrome (systolic vs. diastolic) and careful monitoring of the response to pharmacologic therapy. There is a need to modify treatment in accordance with the patient s response to therapy. 

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. 

Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg). Hypertension results from increased peripheral vascular smooth muscle tone, which leads to increased arteriolar resistance and reduced capacitance of the venous system. Elevated blood pressure is an extremely common disorder, affecting approximately 15% of the population of the United States (60 million people). Although many of these individuals have no symptoms, chronic hypertension—either systolic or diastolic—can lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. The incidence of morbidity and mortality significantly decreases when hypertension is diagnosed early and is properly treated. 

Because of the ease of introducing intravenous and intra-arterial catheters and measuring blood flow and blood pressure, dogs are commonly used to conduct hemodynamic studies. These studies evaluate the effect of the test compound on systolic and diastolic blood pressure, heart rate, cardiac output, dp/dt, respiration, ECG, and ventricular pressure. From these data, effects desirable for treating angina pectoris, congestive heart failure, coronary vasospasm, and myocardial infarction can be detected. 

Several mechanisms have been postulated to underlie the benefits of aldosterone receptor antagonists in heart failure (30). Aldosterone-induced cardiac fibrosis may reduce systolic function, impair diastolic function, and promote intracardiac conduction defects, with the potential for serious dysrhythmias. Aldosterone may also increase vulnerability to serious dysrhythmias by other mechanisms. The diuretic and hemodynamic effects of spironolactone in RALES and EPHESUS were subtle, and there were no significant changes in body weight, sodium retention, or systemic blood pressure. 

The effects of furosemide withdrawal on postprandial blood pressure have been assessed in 20 elderly patients (mean age 73 years) with heart failure and preserved left ventricular systolic function (ejection fraction 61%) (23). In 13 who were able to discontinue furosemide (mean dose 32 mg/day), maximum systolic blood pressure fell significantly from 25 mmHg to 11 mmHg and diastolic blood pressure from 18 to 9 mmHg over 3 months. In the continuation group (mean furosemide dose 21 mg/day), there was no change in the postprandial fall. 

The disappointing results with positive inotropic drugs in treating acute and chronic heart failure may be due to the fact that they increase both systolic and diastolic calcium concentrations in the myocardium (2). 

---