diastolic heart failure
TRANSCRIPT
Residence Report
Diastolic heart Failure
Diagnostic Criteria for Diastolic Heart Failure
Definitive diastolic heart failure Definitive evidence of congestive heart failure = Clinical
symptoms and signs, supporting chest radiography, typical clinical response to diuretics with or without elevated left ventricular filling pressure, or low cardiac index
Objective evidence of normal left ventricular systolic function in proximity of event = LVEF 50 percent or more within 72 hours of event.
Objective evidence of left ventricular diastolic dysfunction = Abnormal left ventricular relaxation or filling or distensibility indices on catheterization.
30% to 50% of patients with active congestive heart failure (CHF) have adequate LV systolic function
Causes of Diastolic Dysfunctionand Heart Failure
Cardiac ischemia Hypertension Aging Obesity Aortic stenosis Uncommon causes
Myocardial disorders (e.g., amyloidosis, sarcoidosis) Pericardial disorders (e.g., Constrictive pericarditis,
Pericardial effusion)
Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
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Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
J ACC 2008;51:18–22 Mechanical Dyssynchrony in Congestive Heart Failure
Trans–mitral-valve Doppler in normal patient
Am. Family Physician 2004;69:2609-16. Diastolic Heart Failure: Challenges of Diagnosis and Treatment
Trans–mitral-valve Doppler in patient of Diastolic heart failure
Am. Family Physician 2004;69:2609-16. Diastolic Heart Failure: Challenges of Diagnosis and Treatment
NEJM 351;11 september 9, 2004 Diastolic Heart Failure
NEJM 351;11 september 9, 2004 Diastolic Heart Failure
NEJM 351;11 september 9, 2004 Diastolic Heart Failure
Diastolic and systolic
NEJM 351;11 september 9, 2004 Diastolic Heart Failure
N Engl J Med 2003;348:2007-18
Management Principles for Patients with Diastolic Heart Failure
Reduce the congestive state Salt restriction Diuretics ACE inhibitors Angiotensin II–receptor blockers
NEJM 351;11 september 9, 2004 Diastolic Heart Failure
Management Principles for Patients with Diastolic Heart Failure
Maintain atrial contraction and prevent tachycardia Cardioversion of atrial fibrillation Sequential atrioventricular pacing Beta-blockers Calcium-channel blockers Radiofrequency ablation modification of
atrioventricular node and pacing
Management Principles for Patients with Diastolic Heart Failure
Treat and prevent myocardial Ischemia Nitrates Beta-blockers Calcium-channel blockers Coronary-artery bypass surgery, percutaneous coronary intervention
Control hypertension Antihypertensive agents
NEJM 351;11 september 9, 2004 Diastolic Heart Failure
Management Principles for Patients with Diastolic Heart Failure
Promote regression of hypertrophy and prevent myocardial fibrosis ACE inhibitors Angiotensin-receptor blockers Spironolactone
NEJM 351;11 september 9, 2004 Diastolic Heart Failure
Goals for Treating Diastolic Heart Failure
Treat precipitating factors and underlying disease.
Prevent and treat hypertension and ischemic heart disease.
Surgically remove diseased pericardium. Improve left ventricular relaxation.
ACE inhibitors Calcium channel blockers
Am. Family Physician Volume 73, Number 5 2006Diagnosis and Management of Diastolic Dysfunction and Heart Failure
Goals for Treating Diastolic Heart Failure
Regress left ventricular hypertrophy (decrease wall thickness and remove excess collagen). ACE inhibitors and ARBs Aldosterone antagonists Beta blockers Calcium channel blockers
Am. Family Physician Volume 73, Number 5 2006Diagnosis and Management of Diastolic Dysfunction and Heart Failure
Goals for Treating Diastolic Heart Failure
Maintain atrioventricular synchrony by managing tachycardia (tachyarrhythmia) Beta blockers (preferred) Calcium channel blockers (second-line agents) Digoxin (controversial) Atrioventricular node ablation (rare cases)
Am. Family Physician Volume 73, Number 5 2006Diagnosis and Management of Diastolic Dysfunction and Heart Failure
Goals for Treating Diastolic Heart Failure
Optimize circulating volume (hemodynamics). ACE inhibitors Aldosterone antagonists (theoretical benefit) Salt and water restriction Diuresis, dialysis, or plasmapheresis
Improve survival. Beta blockers ACE inhibitors
Am. Family Physician Volume 73, Number 5 2006Diagnosis and Management of Diastolic Dysfunction and Heart Failure
Goals for Treating Diastolic Heart Failure
Prevent relapse by intensifying outpatient follow-up. Control blood pressure. Dietary counseling (sodium) Monitoring volume status (daily weights and
diuretic adjustment) Institute exercise program.
Am. Family Physician Volume 73, Number 5 2006Diagnosis and Management of Diastolic Dysfunction and Heart Failure