Systolic dysfunction

Diuretics - Beta blockers (non-ISA) - ACE inhibitors (with systolic dysfunction)... 

Left ventricular dysfunction, also called left ventricular systolic dysfunction, is the most common fonn of heart failure and results in decreased cardiac output and decreased ejection fraction (the amount of blood that the ventricle ejects per beat in relationship to the amount of blood available to eject). Typically, the ejection fraction should be greater than 60%. With, left... 

Until recently, the cardiotonics and a diuretic were the treatment of choice for HE However, other dragp such as the angiotensin-converting enzyme (ACE) inhibitors, and beta blockers have become the treatment of choice during the last several years. See Figure 39-1 for an example of a method of determining treatment for left ventricular systolic dysfunction. See Chapters 23, 42, and 46 for more information on the beta blockers, ACE inhibitors, and diuretics, respectively. 

Managing Heart Failure in Patients with Left Ventricular Systolic Dysfunction ... 

FIGURE 39-1. Management of left ventricular systolic dysfunction. (Adapted from Ammon, S [2001], Managing patients with heart failure, AJN 101 [12] 35.)... 

Adjust dose to achieve heart rate <100 beats/min ° Cautious use in setting of heart failure related to systolic dysfunction... 

Patients with asymptomatic left ventricular systolic dysfunction and hypertension should be treated with P-blockers and ACE inhibitors. Those with heart failure secondary to left ventricular dysfunction and hypertension should be treated with drugs proven to also reduce the morbidity and mortality of heart failure, including P-blockers, ACE inhibitors, ARBs, aldosterone antagonists, and diuretics for symptom control as well as antihypertensive effect. In African-Americans with heart failure and left ventricular systolic dysfunction, combination therapy with nitrates and hydralazine not only affords a morbidity and mortality benefit, but may also be useful as antihypertensive therapy if needed.66 The dihydropyridine calcium channel blockers amlodipine or felodipine may also be used in patients with heart failure and left ventricular systolic dysfunction for uncontrolled blood pressure, although they have no effect on heart failure morbidity and mortality in these patients.49 For patients with heart failure and preserved ejection fraction, antihypertensive therapies that should be considered include P-blockers, ACE inhibitors, ARBs, calcium channel blockers (including nondihydropyridine agents), diuretics, and others as needed to control blood pressure.2,49... 

Although P-blockers should be avoided in patients with decompensated heart failure from left ventricular systolic dysfunction complicating an MI, clinical trial data suggest that it is safe to initiate P-blockers prior to hospital discharge in these patients once heart failure symptoms have resolved.64 These patients may actually benefit more than those without left ventricular dysfunction.65 In patients who cannot tolerate or have a contraindication to a P-blocker, a calcium channel blocker can be used to prevent anginal symptoms, but should not be used routinely in the absence of such symptoms.2,3,62... 

Systolic dysfunction An abnormal contraction of the ventricles during... 

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). 

Causes of systolic dysfunction (decreased contractility) are reduction in muscle mass (e.g., myocardial infarction [MI]), dilated cardiomyopathies, and ventricular hypertrophy. Ventricular hypertrophy can be caused by pressure overload (e.g., systemic or pulmonary hypertension, aortic or pulmonic valve stenosis) or volume overload (e.g., valvular regurgitation, shunts, high-output states). 

Previous Ml, left ventricular hypertrophy, left ventricular systolic dysfunction... 

Left ventricular systolic dysfunction and symptoms such as dyspnea, fatigue, and reduced exercise tolerance... 

Systolic dysfunction Improved hemodynamic performance -decreased end-diastolic dimension -decrease filling pressure -decreased systolic pressure -decreased SVR -decreased mitral regurgitation Arterial vasodilation... 

Heart failure Some ACEIs are effective in the management of CHF, usually as adjunctive therapy and in patients who demonstrate clinical signs of CHF or have evidence of left ventricular systolic dysfunction within the first few days after an acute myocardial infarction (Ml). 

Heart failure post-Mi/ieft-ventricuiar dysfunction post-MI (trandolapril, ramipril) For stable patients who have evidence of left-ventricular systolic dysfunction (identified... 

Congestive heart failure (CHF) post-myocardial infarction (Ml) To improve survival of stable patients with left ventricular systolic dysfunction (ejection fraction 40% or less) and clinical evidence of CHF after an acute Ml. 

Clinical trials of skeletal myoblasts have focused on the treatment of patients with ischemic cardiomyopathy and systolic dysfunction. Overall, these trials have resulted in improved segmental contractility and global LVEF. The preferred delivery route has been surgical intramyocardial injection, and one feasibility trial of transendocardial injection has been reported in the literature so far. 

A recent P MRS study at 1.5 T foimd that the myocardial PCr/ATP ratio was reduced relative to controls in hypertensive patients with diastolic but not systolic dysfunction. In a retrospective study, Zhang et al. showed that the PCr/ p-ATP ratio after coronary artery bypass grafting was significantly higher than prior to grafting (1.71 0.29 after, 1.43 0.24 before), although both ratios were significantly lower than controls (2.13 0.21). ... 

T. Burkhard, C. Herzog, S. Linzbach, 1. Spyridopoulos, F. Huebner and T. J. Vogl, Cardiac P-MRS compared to echocardiographic findings in patients with hypertensive heart disease without overt systolic dysfunction—preliminary results. Eur. f. 

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. 

The pharmacokinetic properties of these drugs are set forth in Table 12-5. The choice of a particular calcium channel-blocking agent should be made with knowledge of its specific potential adverse effects as well as its pharmacologic properties. Nifedipine does not decrease atrioventricular conduction and therefore can be used more safely than verapamil or diltiazem in the presence of atrioventricular conduction abnormalities. A combination of verapamil or diltiazem with 3 blockers may produce atrioventricular block and depression of ventricular function. In the presence of overt heart failure, all calcium channel blockers can cause further worsening of heart failure as a result of their negative inotropic effect. Amlodipine, however, does not increase the mortality of patients with heart failure due to nonischemic left ventricular systolic dysfunction and can be used safely in these patients. 

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