Diastolic Heart Failure
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Diastolic Heart Failure

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Diastolic Heart Failure Diastolic Heart Failure Presentation 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 Dysfunction and 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
  • Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
  • 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 2006 Diagnosis 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 2006 Diagnosis 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 2006 Diagnosis 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 2006 Diagnosis 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 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure