Diastolic Heart Failure

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Diastolic Heart Failure

  1. 1. Residence Report
  2. 2. Diastolic heart Failure
  3. 3. Diagnostic Criteria for Diastolic Heart Failure <ul><li>Definitive diastolic heart failure </li></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>Objective evidence of normal left ventricular systolic function in proximity of event = LVEF 50 percent or more within 72 hours of event. </li></ul></ul><ul><ul><li>Objective evidence of left ventricular diastolic dysfunction = Abnormal left ventricular relaxation or filling or distensibility indices on catheterization. </li></ul></ul>
  4. 4. <ul><li>30% to 50% of patients with active congestive heart failure (CHF) have adequate LV systolic function </li></ul>
  5. 5. Causes of Diastolic Dysfunction and Heart Failure <ul><li>Cardiac ischemia </li></ul><ul><li>Hypertension </li></ul><ul><li>Aging </li></ul><ul><li>Obesity </li></ul><ul><li>Aortic stenosis </li></ul><ul><li>Uncommon causes </li></ul><ul><ul><li>Myocardial disorders (e.g., amyloidosis, sarcoidosis) </li></ul></ul><ul><ul><li>Pericardial disorders (e.g., Constrictive pericarditis, Pericardial effusion) </li></ul></ul>Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
  6. 6. Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
  7. 7. Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
  8. 8. J ACC 2008;51:18–22 Mechanical Dyssynchrony in Congestive Heart Failure
  9. 9. Trans–mitral-valve Doppler in normal patient Am. Family Physician 2004;69:2609-16. Diastolic Heart Failure: Challenges of Diagnosis and Treatment
  10. 10. 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
  11. 11. NEJM 351;11 september 9, 2004 Diastolic Heart Failure
  12. 12. NEJM 351;11 september 9, 2004 Diastolic Heart Failure
  13. 13. NEJM 351;11 september 9, 2004 Diastolic Heart Failure
  14. 14. Diastolic and systolic NEJM 351;11 september 9, 2004 Diastolic Heart Failure
  15. 15. N Engl J Med 2003;348:2007-18
  16. 16. Management Principles for Patients with Diastolic Heart Failure <ul><li>Reduce the congestive state </li></ul><ul><ul><li>Salt restriction </li></ul></ul><ul><ul><li>Diuretics </li></ul></ul><ul><ul><li>ACE inhibitors </li></ul></ul><ul><ul><li>Angiotensin II–receptor blockers </li></ul></ul>NEJM 351;11 september 9, 2004 Diastolic Heart Failure
  17. 17. Management Principles for Patients with Diastolic Heart Failure <ul><li>Maintain atrial contraction and prevent tachycardia </li></ul><ul><ul><li>Cardioversion of atrial fibrillation </li></ul></ul><ul><ul><li>Sequential atrioventricular pacing </li></ul></ul><ul><ul><li>Beta-blockers </li></ul></ul><ul><ul><li>Calcium-channel blockers </li></ul></ul><ul><ul><li>Radiofrequency ablation modification of atrioventricular node and pacing </li></ul></ul>
  18. 18. Management Principles for Patients with Diastolic Heart Failure <ul><li>Treat and prevent myocardial Ischemia </li></ul><ul><ul><li>Nitrates </li></ul></ul><ul><ul><li>Beta-blockers </li></ul></ul><ul><ul><li>Calcium-channel blockers </li></ul></ul><ul><ul><li>Coronary-artery bypass surgery, percutaneous </li></ul></ul><ul><ul><li>coronary intervention </li></ul></ul><ul><li>Control hypertension </li></ul><ul><ul><li>Antihypertensive agents </li></ul></ul>NEJM 351;11 september 9, 2004 Diastolic Heart Failure
  19. 19. Management Principles for Patients with Diastolic Heart Failure <ul><li>Promote regression of hypertrophy and prevent myocardial fibrosis </li></ul><ul><ul><li>ACE inhibitors </li></ul></ul><ul><ul><li>Angiotensin-receptor blockers </li></ul></ul><ul><ul><li>Spironolactone </li></ul></ul>NEJM 351;11 september 9, 2004 Diastolic Heart Failure
  20. 20. Goals for Treating Diastolic Heart Failure <ul><li>Treat precipitating factors and underlying disease. </li></ul><ul><li>Prevent and treat hypertension and ischemic heart disease. </li></ul><ul><li>Surgically remove diseased pericardium. </li></ul><ul><li>Improve left ventricular relaxation. </li></ul><ul><ul><li>ACE inhibitors </li></ul></ul><ul><ul><li>Calcium channel blockers </li></ul></ul>Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
  21. 21. Goals for Treating Diastolic Heart Failure <ul><li>Regress left ventricular hypertrophy (decrease wall thickness and remove excess collagen). </li></ul><ul><ul><li>ACE inhibitors and ARBs </li></ul></ul><ul><ul><li>Aldosterone antagonists </li></ul></ul><ul><ul><li>Beta blockers </li></ul></ul><ul><ul><li>Calcium channel blockers </li></ul></ul>Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
  22. 22. Goals for Treating Diastolic Heart Failure <ul><li>Maintain atrioventricular synchrony by managing tachycardia (tachyarrhythmia) </li></ul><ul><ul><li>Beta blockers (preferred) </li></ul></ul><ul><ul><li>Calcium channel blockers (second-line agents) </li></ul></ul><ul><ul><li>Digoxin (controversial) </li></ul></ul><ul><ul><li>Atrioventricular node ablation (rare cases) </li></ul></ul>Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
  23. 23. Goals for Treating Diastolic Heart Failure <ul><li>Optimize circulating volume (hemodynamics). </li></ul><ul><ul><li>ACE inhibitors </li></ul></ul><ul><ul><li>Aldosterone antagonists (theoretical benefit) </li></ul></ul><ul><ul><li>Salt and water restriction </li></ul></ul><ul><ul><li>Diuresis, dialysis, or plasmapheresis </li></ul></ul><ul><li>Improve survival. </li></ul><ul><ul><li>Beta blockers </li></ul></ul><ul><ul><li>ACE inhibitors </li></ul></ul>Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure
  24. 24. Goals for Treating Diastolic Heart Failure <ul><li>Prevent relapse by intensifying outpatient follow-up. </li></ul><ul><ul><li>Control blood pressure. </li></ul></ul><ul><ul><li>Dietary counseling (sodium) </li></ul></ul><ul><ul><li>Monitoring volume status (daily weights and diuretic adjustment) </li></ul></ul><ul><ul><li>Institute exercise program. </li></ul></ul>Am. Family Physician Volume 73, Number 5 2006 Diagnosis and Management of Diastolic Dysfunction and Heart Failure

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