Heart Failure (Diastolic)
DEFINITION
Heart failure (see card) in which the principle abnormality is that
of relaxation and filling, as opposed to contracting and expelling blood.
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INCIDENCE
See Heart Failure card.
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AETIOLOGY
Pathogenesis
Failure of the ventricles to relax and fill normally.
May be due to:
i) Increased resistance to ventricular filling.
ii) Impaired ventricular relaxation.
Sieve
(See specific cards for seives)
Increased Resistance to Filling
Constrictive pericarditis.
Restrictive cardiomyopathy.
Hypertensive cardiomyopathy.
Hypertrophic cardiomyopathy.
Impaired Relaxation
Acute myocardial ischamia.
Hypertrophic cardiomyopathy.
Myocardial fibrosis and infiltration.
- dilated, chronic ischaemic, and restrictive cardiomyopathy.
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BIOLOGICAL BEHAVIOUR
Pathophysiology
Failure of the ventricles to relax and fill normally.
Causes a reduced ventricular diastolic capacity.
And hence decreased stroke volume
And heart failure.
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MANIFESTATIONS
See Heart Failure card.
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INVESTIGATIONS
See Heart Failure card.
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MANAGEMENT
Aims
1. Minimise diastolic dysfunction.
2. Reduce congestion.
Minimise dysfunction
Treat and prevent myocardial ischaemia.
ACEi stops fibrosis, aids remodelling.
Spironolactone.
Control hyperT, promote hypertrophy regression.
Maintain atrial contraction - cardiovert if needed.
Prevent tachy, promote brady - beta, ca channel blockers.
Promote ventricle relaxation: Beta-adrenergics, systolic unloading, treat
ischaemia, Ca++ blockers.
Reducing Congestion
Salt restriction.
Diuretics.
ACEi.
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