Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Diastolic Heart Failure

5,301 views

Published on

Published in: Health & Medicine
  • A practicing internist doing echo since 1998
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

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

×