Transcript Systolic Versus Diastolic Failure

Systolic Versus Diastolic Failure
Forms of Heart Failure
Sytolic Failure
• Inability of the ventricle
to contract normally
and expel sufficient
blood
• Inadequate cardiac
output with weakness,
fatigue, reduced
exercise tolerance
(hypoperfusion)
Diastolic Failure
• Inability to relax or fill
normally (elevation of
filling pressures)
• Due to increased
resistance to ventricular
diastolic capacity,
impaired ventricular
relaxation, and
myocardial fibrosis and
infiltration
Management
Congestive Heart Failure
• Patients With Reduced Left Ventricular
Ejection Fraction
– If with fluid retention:
• Use diuretics (thiazides)
– Medications that should be AVOIDED:
• Anti-arrhythmics
• Calcium channel blockers
• NSAIDs
Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977
Congestive Heart Failure
• Patients With Reduced Left Ventricular
Ejection Fraction
– Recommendations concerning aldosterone
antagonists:
• carefully selected patients with moderately severe or
severe HF symptoms and recent decompensation or
with LV dysfunction early after MI
Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977
Congestive Heart Failure
• Patients With Refractory End-Stage Heart
Failure (Stage D)
– Intravenous Peripheral Vasodilators and Positive
Inotropic Agents:
• hospitalized frequently for clinical deterioration, and
during such admissions, they commonly receive
infusions of both positive inotropic agents
(dobutamine, dopamine, or milrinone) and vasodilator
drugs (nitroglycerin, nitroprusside, or nesiritide)
Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977
Congestive Heart Failure
The Hospitalized Patient
Common Factors That Precipitate
Hospitalization for Heart Failure
• Noncompliance with medical regimen, sodium
and/or fluid restriction
• Acute myocardial ischemia
• Uncorrected high blood pressure
• Atrial fibrillation and other arrhythmias
Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977
Congestive Heart Failure
The Hospitalized Patient
Common Factors That Precipitate
Hospitalization for Heart Failure
• Recent addition of negative inotropic drugs
(e.g., verapamil, nifedipine, diltiazem, beta
blockers)
• Pulmonary embolus
• Nonsteroidal anti-inflammatory drugs
Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977
Congestive Heart Failure
The Hospitalized Patient
Common Factors That Precipitate
Hospitalization for Heart Failure
• Excessive alcohol or illicit drug use
• Endocrine abnormalities (e.g., diabetes
mellitus, hyperthyroidism, hypothyroidism)
• Concurrent infections (e.g., pneumonia, viral
illnesses)
Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977