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Diastolic%20Heart%20Failure

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'The very essence of cardiovascular medicine is recognition of early heart failure. ... of the DHF. Presence of sighs or symptoms of congestive heart failure ... – PowerPoint PPT presentation

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Title: Diastolic%20Heart%20Failure


1
Diastolic Heart Failure
Carmen B. Gomez MD Eugene Yevstratov MD
The very essence of cardiovascular
medicine is recognition of early heart failure.
Sir Thomas Lewis 1933
2
Introduction
  • Diastolic heart failure has emerged over the
    last 10 years as a separate clinical entity.
    Diastolic heart failure accounts for
    approximately one third of all heart failure
    cases, especially in an elderly population, and
    its natural history, with an annual mortality
    rate of 8, is more benign than other forms of
    heart failure with an annual mortality of 19. A
    need has therefore grown to establish precise
    criteria for the iagnosis of diastolic heart
    failure.

3
Requirments for Diagnostic of the DHF
  • Presence of sighs or symptoms of congestive heart
    failure
  • Presence of normal or only midly abnormal left
    ventricular systolic function
  • Evidence of abnormal left ventricular
    relaxation(filling,diastolic distensibility or
    diastolic stiffness)

4
Pathophysiology
  • Impaired relaxation
  • Increase passive stiffness
  • Endocardial and pericardial disordersw
  • Microvascular flow.Myocardial turgor
  • Neurohormonal regulation

5
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6
PathophysiologyImpaired Relaxation
  • Epicardial or microvascular ischemia
  • Myocite hypertrophy
  • Cardiomyopathies
  • Aging
  • Hypothyroidism

7
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8
PathophysiologyIncrease Passive Stiffness
  • Diffuse fibrosis
  • Post-infarct scarring
  • Myocyte hypertrophy
  • Infiltrative (amyloidosis, hemochromatosis,
    Fabrys disease)

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10
PathophysiologyEndocadial, Pericardial Disorders
  • Fibroelastosis
  • Mitral or tricuspid stenosis
  • Pericardial constriction
  • Pericardial tamponade

11
PathophysiologyEndocadial, Pericardial Disorders
12
PathophysiologyMicrovascular Flow,Myocardial
Turgor
  • Capillary compression
  • Venouse engorgement

13
PathophysiologyMicrovascular Flow,Myocardial
Turgor
14
PathophysiologyNeurohormonal Regulation, Other
  • Upregulated renin-angiotensin system
  • Volume overload of the contralatetal ventricle
  • Extrinsic compression by tumor

15
Diagnosis
  • Increased ventricular filling pressure with
    normal systolic function.
  • Incresed ventricular pressure with preserved
    systolic function and normal ventricular volumes.
  • Increased left atrial and pulmonary capillary
    wedge pressure.
  • Clinical symptoms and signs.

16
Clinical Signs and Symptoms
  • Evidence of raised left atrial pressure
  • Exertional dyspnoea
  • Orthopnoea
  • Gallop sounds
  • Lung crepitations
  • Pulmonary oedema
  • Exercise intolerance

17
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20
Evidence of Abnormal left Ventricular Relaxation
  • LVdP/dt minlt1100 mmHg
  • IVRTlt30ygt92 ms, IVRT3050ygt100 ms, IVRTgt50ygt105
    ms and/or Ùgt48 ms
  • LVEDPgt16 mmHg or mean PCWgt12 mmHg
  • PV A Flow gt35 cm . s"1
  • bgt027 and/or bgt16

21
Management of DHF
  • Reduce symptoms
  • Control hypertension
  • Prevent myocardial ischemia
  • There is no specific therapy for DHF

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23
Management of DHF
  • Diuretics provide the most symptoms relief if
    fluid retentionn is a future
  • ACE inhibitors and ß Blockers complement
    diuretics well
  • Central sympatholytics hypertensive episodes
  • Nitrates preventing ischemia
  • Trimetazidine as a metabolic support

24
Conclusion
Until further evidence is available from
randomized therapeutic trials, clinicians should
focus on a few general principles in the
treatment of DHF Reduce volume overload Slow
the heart rate Control hypertension, Relieve
myocardial ischemia.
25
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