DIASTOLIC HEART FAILURE
Diastolic heart failure (heart failure symptoms with “preserved ventricular function”) has become a common problem, especially in the hypertensive elderly female population. Patients usually have normal LV volume and normal or near-normal systolic function. Often the patient exhibits LV hypertrophy on ECG and ultra-sound. Ischemic heart disease can also result in diastolic dysfunction because of the decreased relaxation of the stiff left ventricle due to myocardial ischemia. Patients with hypertrophic and restrictive cardiomyopathies as well as patients with constrictive pericarditis have impaired ventricular relaxation, high LVEDP, and high left atrial pressure, which may result in pulmonary congestion despite a normal, hypernormal, or near-normal ejection fraction. The impediment to diastolic filling probably results from fibrosis, scarring, or infiltration of the ventricle. At autopsy, typical findings include hypertrophy of LV wall that is disproportionate to the LV cavity. During life, cardiac ultrasound reveals signs of concentric LV hypertrophy (see Plate 6-140).
Approximately 50% of patients with clinical
heart failure (HF) have a preserved LV ejection fraction (PEF), and thus HF-PEF
(“hefpef”) is now used instead of “diastolic dysfunction.” This condition is much
more common in elderly women with hypertension than in similar men. This condition
is not benign, but most studies indicate that mortality in HF-PEF patients is
not as severe as in patients with heart failure caused by systolic dysfunction.
Patients with repeated admissions for HF, regardless
of their EF, are a high-risk group for readmission and should be a population targeted
in designing future trials of HF-PEF. The relationship of heart rate to morbidity
and mortality is well known in coronary artery disease and in HF with low EF. The
relationship between heart rate and poor outcome is also present in patients with
HF-PEF.
Current management strategies for patients
with pulmonary congestion related to hypertension and HF-PEF should consist of diligent observation of
the patients by frequent office visits, home health professionals, or telemedicine
protocols in which patients weigh themselves daily and control hypertension, diabetes,
salt intake, heart rate, and state of hydration. To accomplish this, patients should
receive an ACE inhibitor or ARB, beta blocker, and diuretic and any other antihypertensive
agent if blood pressure is not controlled.
.webp "Scrotal Skin Diseases: Causes, Symptoms, Diagnosis, and Treatment")
