Systolic Heart Failure

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Systolic Heart Failure
Eugene Yevstratov MD
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Definition

• Inability to pump an adequate volume of blood
  and/or to do so only from an abnormally elevated
  filling pressure,is that heart failure, can be
  caused by an abnormality in systolic function
  leading to a defect in the expulsion of blood
  i.e.
• Systolic Heart Failure

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Causes

• Coronary artery disease
• Valvular heart disease
• Hypertension and aging
• Diabetes
• Dilated cardiomyopathy

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NYHA classification of heart failure symptoms

• Class 1 No limitations, ordinary physical
  activity does not cause undue fatige, dyspnoea or
  palpitation (asymptomatic LVD)
• Class 2 Slight limitation of physical activity,
  such patients are comfortable at rest
  (symptomatically mildheart failure)
• Class 3 Marked limitation od physical activity,
  less then ordinary physical activity will lead to
  symptoms
• (symptomatilcally moderadeheart failure)

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Echo Morphological Classification

• Segmental dysfunction
• Focal scarring/dyskinesis most likely ischemic
  origin,but significant regional asymmetry (even
  without LBBB) often seen in DCM
• Global dysfunction
• May be due to any of the causes of systolic
  dysfunction, including CAD

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SHF vs Normal Heart Value

• End diastolic volume 135 mVm2 (N80)
• End Systolic volume 105 ml/m2 (N40)
• Stroke volume 30 ml/m2 (N40)
• Ejection fraction 20 (N50)
• End diastolic pressure 25 mmHg (N10)

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Left ventricular systolic dysfunction is defined
as an ejection fraction of less than 40
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Clinical Symptoms

• Dyspnoea
• Fatigue
• Periferal oedema
• Orthopnoea
• Paroxysmal nocturnal dyspnoea

Hallmark symptoms
Spesific symptoms
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Nearly 50 of patients with heart failure die
within five years of the onest of symptoms
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Identification of SHF
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CAD producing ischemic cardiomyopathy is the most
common cause of left ventricular systolic
dysfunction
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Physiology
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Preload
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Afterload
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LV remodeling
Pressure overload
Volume overload
normal
Increased DP
Increased SP
Icreased Ss
Icreased Ds

Series addition of new safcomeres
Parallel addition of new myofibrils
Chamber enlargement
Wall thickening
Concentric hypertrophy
Eccentric hypertophy
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Ventricular Hypertrophy
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Systolic vs Diastolic Dysfunction
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Treatment of SHF

• Diuretics
• Positive Inotropics Drugs
• Direct-Acting Vasodilators
• Neurohormonal Antagonists

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Treatment of SHF
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Tailored Therapy for Advanced Heart Failure

• IV nitroprusside and diuretics tailored to
  hemodynamics goals
• PCW lt15mmHg
• Measurment of baseline hemodynamics
• SVRlt 1200 dynes/s/cm-5
• RA lt 8mmHg
• SBP gt 80 mmHg

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• Definition of optional hemodynamics by 23 48
  hours
• Titration of high-dose oral vasodilators as
  nitroprusside weaned
• (combination of captopril, ISDN, hydralazine as
  needed as alternative or addition)
• Monitored ambulation and diuretic adjustment for
  24 48 hours
• Maintain digoxin levels 1.0 2.0 ng/dl if no
  contraindication

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Eugene Yevstratov MD