DIASTOLIC DYSFUNCTION AND HEART FAILURE PHYSIOLOGY, HISTORICAL FEATURES AND CLINICAL PERSPECTIVEMedicine Resident RoundsSeptember 28, 2007Jacobi Hospital

TERMINOLOGYDiastolic dysfunctionAlteration in active or passive relaxation of the LVDiastolic heart failureSigns/symptoms of heart failure w normal ventricular function/size and findings of abnormal diastolic functionSystolic heart failureSigns/symptoms of heart failure w abnormal ventricular function/size.

ISOVOLUMIC (EARLY) RELAXATIONENERGY DEPENDENT

Phases of diastole

Elevated Left Ventricular Diastolic Pressure Causes Pulmonary Congestion

HISTORICAL CONCEPTS OF DIASTOLIC FUNCTION

1940-1965 Experimental Heart failure was associated with increased diastolic pressures (volume overload or global ischemia)Objective confirmation of Heart failure was an elevated diastolic pressure (during cardiac catheterization) 1965 Braunwald editorial noting that marked increases observed in hypertrophic hearts without evidence of clinical heart failure. 1970 Report of reversible diastolic pressure increase without enlargement of the LV heart size during ischemia . 1975 Non invasive techniques of evaluating diastolic volume changes, wall thickness and LV diastolic diameter

SPONTANEOUS ANGINA EFFECT ON SYSTOLIC & DIASTOLIC PRESSURE

LV DIASTOLIC PRESSURE CHANGESDURING EXERCISE INDUCED ANGINA50--- 50---

CHANGES IN LV DIASTOLIC PRESSURE AND VOLUME DIURING ANGINA -- INDUCED BY ATRIAL PACING DWYER CIRC 1970

LV ANATOMIC CHANGES ALTERS DISTENSIBILITYin CHRONIC NON-ISCHEMIC DISORDERSMyocardial cell Hypertrophy occurs and corresponds to wall thickness as per Echocardiogram

Active fibrotic process occurs with increase in the amount of collagen and shift to less pliable collagen

LV DIASTOLIC DISTENSIBILITY

Stiffness- Compliance- Distensibility are best quantified by the LV pressure / volume relationship

Pressure-Volume CurveDiastolic Dysfunction

LV Volume (ml)

LV Pressure (mm Hg)

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Increased Chamber Stiffness

Only onetype of diastolic dysfxn i.e. also decreased relaxation

See Braunwald pg 402

Assessment of Diastolic Function EchocardiogramNormal Heart size and normal contraction patternE/A flow velocity ratio : in DD E declines and A increases (normal: 1.2- 2 & Abnormal

COMMON CAUSES OF DIASTOLIC DYSFUNCTION

Ischemia (potentially reversible delay in or incomplete early relaxation) Acute Hypertension (potentially reversible delay in or incomplete early relaxation)Infarction (increased passive stiffness)Chronic Hypertension with Hypertrophy (increased passive stiffness)Aortic Stenosis & IHSS (increased passive stiffness)Idiopathic Hypertrophic Cardiomyopathy (increased passive stiffness)Diabetes and Obesity (increased passive stiffness)

TRIGGERS TO PULMONARY CONGESTION IN PATIENTS WITH DIASTOLIC DYSFUNCTION

Volume overloadIncreased salt & water intakeChronic renal diseaseIatrogenic (procedure or surgery related)Severe chronic anemiaTachycardia Atrial Fibrillation with and without rapid VRHypertension (>200 mmHg)Ischemia

RELATIONSHIP BETWEEN LV SYSTOLIC PRESSURE AND LV DIASTOLIC PRESSURE IN PATIENTS WITH NORMAL CORONARY ARTERIES DWYER ET AL AHJ 2000

R = .44

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SYSTOLIC PRESSURE (mmHg)

DIASTOLIC PRESSURE (mmHg)

RELATIONSHIP OF SYSTOLIC AND DIASTOLIC PRESSURE

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&A

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AGE

LV DIASTOLIC PRESSURE

RELATIONSHIP BETWEEN AGE AND LV DIASTOLIC PRESSURE

Sheet1

Last NameFirst NameSexAgeRACEProcadateBMITypelvslvedEFCORDIS%

REEDDOROTHYf72b10-Sep-9618H1458550

MCCOYCONSTANCEf61b4-Jan-9618H15013600

CAPUTOCAROLEf57c29-Aug-9618n144115000

RAMOSEMILIAf74h28-Aug-9619H14916600

WILLIAMSMARY ANNf51c23-Oct-9619H15120600

GRANDUKEJAMESm88b1-Jul-9619H16825550

ERDEKCONSTANCEf65c4-Mar-9719H17822550

MCKENNAJOSEPHm50c20-Mar-9719n10612550

BOULDENMILDREDf63b17-Jun-9620H19422650

HERNANDEZGISELAf48h30-Dec-9620DH13020600

CONTEEILEENf47c18-Nov-9620n129186000.2366572445

MELICKGLORIAf69c28-Aug-9621H15118550

BEREZNAYAIRINAf59c12-Feb-9721H12611650

EUGENEDELIVRANCEm72b1-Apr-9621n13721500

MESSINKGREGORYm40c18-Jul-9621n9619850

ROMANOANTONETTEf68c30-Oct-9621n13013700

JOHNSONVIOLAf69b25-Jun-9622H15927700

HOLMESANDERSONm47b2-May-9622H11519600

GARNESROBERTm41b6-Mar-9622H16518550

PADUAGENEROSAf80h########22H14817500

ARCEMARIAf57h14-Feb-9722H1026600

CONTENTMARIEf73b27-Sep-9622D1439550

HERNANDEZJULIOm40h23-Feb-9622n13612600

GAGANANDREWm38c28-Apr-9722n14011550

MERCURIOJOSEPHm47c2-Jun-9722n9715550

KIRKLANDLARRYm57b16-Sep-9623H15129550

VANDUNKEDNAf80b27-Jun-9623h20530652

EMERSONDOROTHYf69b28-Feb-9623H153236500.44

MARTINEZLUISm61h5-Jun-9623H14222552

BOBEEFRAINm66h23-Apr-9723H14423551

RODRIGUEZNIEVESm44h########23H11717550

ALLANGEORGEm63c9-Jun-9723H14018600

COOPERWILLIAMm58b30-Aug-9623DH16221750

SEMIDEYDAVIDM49h5-Dec-9623DH15336500

VALDEZVIRGINIAf61a########23DH17023500

BRYDIESHIRLEYf46b18-Apr-9623n14716550

WEBSTERGEORGIAf79b18-Dec-9623n13810550

LIDIASURIf66h10-Apr-9723n13511550

MOLENAARCARAf39h15-Jun-9723n13013600

ALVAREZMARIAf78h25-Sep-9624H13018550

SEBESTAVALERIEf72c3-Jan-9624H16513800

RIBEIROGEORGEm69o14-Apr-9724H14911551

HUTCHERSONFRANCISf60b18-Sep-9624DH14520600

MONTELEONEFAUSTINAF76o20-Sep-9624n1533550

GARYCHARLOTTEf46b22-Oct-9625H21737600

ABUELHAWAMARIAMf67o21-Aug-9625H14020500

VIRELLAMARYf61b11-Nov-9625H16718550

ALVAREZMIGUELm62h25-Jul-9625H12010550

GERSTHNERMARYf77c13-Sep-9625H18123750

WHITAKEREDWARDm59b16-Jan-9625H13820550

SHAHMADHUSUDANM55o1-May-9625H14021500

ORTIZLUISm53h26-Jun-9625H20016652

WALKERJANETf67b6-Jan-9725H170176020.24

BRODBECKARTHURm56c########25H14722650

RODRIGUEZARCADIOm60H12-Jun-9725H13011550

THOMASERNESTm43b13-Feb-9725H11214600

PEREZISABELf66h19-Dec-9625DH13523602

TORRESCECILIOm62h10-Jan-9625DH16222552

SMITHETHELf64b24-Jan-9725DH1587550

ROBESPIERREJOSEPHm59b13-Feb-9725D12821500

LINJYNm29o7-Feb-9625n10610750

BARCLIFFEDOROTHYF74c5-Sep-9625n14111550

DANQUAHGENEVIEVEf56b7-Feb-9725n14015600

LEEWILFREDm70b26-Mar-9725n12222550

RIOSVICTORm54h########25n1598550

BYRDJOSEPHINEf75b3-Oct-9626H20017650

COTTOFRANCISCAf58h12-Jan-9626H13513500

DAVISROBERTm38b15-Mar-9626H12220550

KEYWILLIE MAEf78b26-Mar-9726H15423550

WASILEWSKISTEPHINm69c25-Apr-9726H15922552

JOYNERMARYf68b8-Apr-9726H20939600

MARQUEZCARMENF49h16-Jan-9626DO12023652

WILTSHIRELIONELm72b18-Oct-9626n15012500

WILLIAMSKATHLEENf51b27-Sep-9626n16025600

MANTILLACARMENf44h11-Nov-9626n13010600

FORDREATHAf76b12-Mar-9726n1268600

OCEGUERAJOVITAf62h25-Sep-9627HO190275500.59

BEALCHARLESm57b6-Mar-9627HO15320600

AUSTONBETTYf58b19-Jul-9627HO18720500

FAJARDOMARIAf76h18-Dec-9627HO1456500

PABONMARIAf67h16-Feb-9627HO1547750

DEBERRYLEWISm63b6-Jan-9727HO16022600

FERRANTEMARYf75c6-May-9727HO16018551

CASTILLOSONIAf45h6-Feb-9727HO19120650

CARUSOEGIDIOm55c25-Apr-9727HO13718550

JOHNSONROBERTm73b########27HO14322602

FREEMANVIRGINIAf60b13-Feb-9727HO16314550

FRIENDERNESTm72b25-Jun-9627DHO16025650

SANTIAGOCATALINAf53h6-Feb-9727DHO15516500

REEDJOHNNIEm65b13-Feb-9627O12618650

MAZAMATEOm57h29-Jan-9727O12716550

NIERMANNHILDEGARDf71c17-Jun-9628H15325550

DIAZLORENZAf64h27-Nov-9628HO20025600

GALANJUANAf56h23-Apr-9628HO1286650

BOYDHUBERTM58b6-May-9628HO14715601

KELLERNETTIEf61b7-Jan-9728HO15029600

MENDOZAREINAf57h22-Jan-9728HO14125650

MINNICKJAMESm62c28-Jan-9728HO14015650

BEGONCURDYM42b29-Apr-9728HO16120650

TORRESJUANm42h########28DHO1478600

HALLRITAf45h7-Aug-9628O11810600

DEBRITOFERNANDOm64h26-Aug-9628O13412550

CLEMONSVANESTERm44b29-Sep-9628O1409500

RIVERAMIRIAMf51h26-Feb-9728O15524552

WILSONRODGERm61c########28O13422551

FIGUEROACARLOSm79h16-Feb-9629ho164185500.18

NIEVESCARMENF76h2-Dec-9629HO17624550

LOCKHARTMYRNAf55b19-Dec-9629HO12230600

SMITHVICTORIAf50b25-Jul-9629HO16023550

TRETSISANDREASm46c########29HO11724600

D'AQUILABERNARDm76c########29HO19123501

BROWNRIDGENELLIEf76b3-Mar-9729HO15913601

TAYLORDORENEf58c########29HO13514550

PEACEJAMESm74b6-May-9629DH11720552

ERAZOGLADYSf41b9-Aug-9629DO1138500

CELESTERMAGGIEf57b1-Dec-9629DO17820700

BOISSELLEMATILDAf51b########29O16816600

RODRIGUEZPAULAf64h27-Sep-9630HO12415650

JACKSONGWENDOLYNf52b6-Aug-9630HO20528502

DURHAMBLACKSCLARENCEm63b9-Feb-9630HO10618650

DIXONDORoYf59b16-Jan-9630HO15012650

SOUZAWANDIRAf47h3-May-9630HO21026600

BROWNJ.W.m75b10-Apr-9730HO17010700

MCCLOUDNELLIEf66b19-Dec-9630DO18424550

BROWNEARNESTm54b17-Apr-9630DO14618550

SLATERBEVERLYf50b15-Jul-9631HO16716550

RODRIGUEZJUANITAf60c26-Feb-9631HO19016600

DELLIPAOLIJEFFREYm29c########31HO10518600

GENAOMARIANAf55h6-Nov-9631DHO14618600

RUIZJOSEFINAf76h27-Nov-9631DHO19515700

NUNESMARIAf65o13-Nov-9632HO17513650

SIMMONSCLARISEF43b10-Dec-9632ho14219500

ST. PIERREMICHAELm51b13-Feb-9632HO1791750

MCCUTCHENHATTIEf54b26-Apr-9632HO16431550

WILLIAMSELAINEf45b1-May-9632HO15823500

JEFFERSONULYSSESm73b6-Jun-9632HO14515600

MAYFIELDWILLISM68b24-Mar-9732HO17327550

WILLIAMSFLORENCEF70b17-Jan-9732HO16027650

BAUERLOUISEf63c31-Mar-9732DHO13018550

GARCIAANGELAf53h5-Apr-9732DHO11312650

COBIELLAFRANCISCOm55h9-Dec-9632O1158550

CASTILLOMARIAf57h1-Nov-9632O17028552

LEVITZCHARLESm54c9-May-9632O13614550

HOFFMANWILLIAMm30c########32O13116600

MARTINEZMARIAf61h########32O11818551

QUINTYNERACHELf72b########33ho15022600

HERNANDEZMANELAf71h27-Jan-9733HO13414600

BALOMOSSIEf70b9-Jan-9733HO15027600

DAVISBETTYf46b8-Mar-9633DHO15121800

VELEZVICTORIANAf61h18-Sep-9633O15024600

WARDJOHNm64c6-Nov-9633O15027600

HARRINGTONVERGIEf59b8-Nov-9633O12410650

DANIELSCASSANDRAf57b12-Mar-9633O15927550

COOPERJOSEPHm42b21-Apr-9733O14411550

JOHNSONCASANDRAF49b10-Jun-9634HO20814650

BANKSAMELIAF68b25-Nov-9634HO17330652

DERINGCARMINEm39c26-Apr-9634HO16318550

HUDSONJESSIEf53b26-Aug-9634DO1488602

GOMEZANAf67h########34DHO16018650

PEAKMARYf686-May-9735H16115600

SMITHBARBARAf75b29-Oct-9635HO17519750

SOUZADELORESf63c########35HO16527550

TILLERYWILLIEm50b14-Mar-9735HO15012550

PEREIRAADELINOm48h########35HO17913550

BROXTONLEROYm58b16-Jan-9735HO12013500

HOLMESFLORENCEf50b9-Feb-9635O12017550

YABLONLUBOVf75c29-Jan-9636H16313650

EVANSBEVERLYf36b11-Oct-9636HO18328600

PLAZARAMONm64h18-Apr-9636HO14321550

MURPHYDENISEf40b8-Mar-9636DO15322550

LEBRONPATRICIAf50h25-Oct-9636DHO12014650

JOHNSONTHOMASM56b7-Feb-9736DHO15621600

ROBINSONDELVENEm54b25-Apr-9736O14113550

KOMOROSKICHESTERM56c14-Mar-9736O14017550

WEBSTERVIRGINIAf56b30-Aug-9637HO20330650

COOPERJENNEHm66b########37HO13613750

VALLESMYRTHAf49h13-Jun-9637DHO15018600

COLEMANWYLIEm62b########37DHO19128600

PEREZJUANM43h7-Apr-9737DHO15336950

MARTINLUCILLEf72b9-May-9737DHO16028600AGE:LVEDAGE:LVSP

RICHARDSONSHARRONf31b28-Jan-9738HO190266000.04541365630.2362322605

FORDBARBARAf52b6-Jan-9738DHO18233600

REYESESPANINODAM44h16-Sep-9639HO14218550

PHALONMARSHAF57c3-May-9639HO13713700

QUINONESSIXTOm79h3-Feb-9739HO13621550

MOSESROBERTm47b9-Jan-9739HO16626600

DORSEYLILLIEF62b11-Mar-9639DO18719500

HARDYMARCELLAf47b2-Feb-9639DHO19035600

HOLLANDANITAf40b30-Jul-9640HO14018500

SAUNDERSMADELINEF50b9-Dec-9640HO12010552

MCNAIRJOSEPHm53b8-Nov-9642HO15212500

PEMBERTONSAMUELM52b20-Jun-9642O11421550

ROGERSJEANf46b27-Aug-9643HO18016650

ROGERJEANf46b27-Aug-9643HO18016650

ROSEMAXIEf53b14-Feb-9743DHO12022600

VALENTINEPORTIAf47b3-Apr-9744HO18023550

HIGGSANGELOm46b5-Jun-9744HO15431600

HARDYCHRISTINEf46b########46HO17435500

BEEKSGEORGIANNAf52b7-Aug-9646DHO21020650

SERMONSGLORIAf43b7-May-9747HO16028600

ESPINMICAELAm66h17-Apr-9748HO16920550

GONZALEZMARIAf60h27-Nov-9649HO17324600

BURNETTNINAf63b26-Jul-9652HO23234550

HARRISSHIRLEYf49b29-Jul-9654HO13824550

52.173913043543.2608695652162.434782608722.565217391357.6086956522

29.48768472911521959

15940

15432

15027

14422

0.4356442741

0.085978055

First NameSexAgeRACEBMITypelvslvedEF

COLEMANBRENDAf42bl16d1681935

REEDDOROTHYf72b18H145855

MCCOYCONSTANCEf61b18H1501360

GRANDUKEJAMESm88b19H1682555

BOULDENMILDREDf63b20H1942265

KABAABRAHAMm33bl20h1621520

EUGENEDELIVRANCEm72b21n1372150

BANKSELIJAHm76bl21h1482330

CONTENTMARIEf73b22D143955

GARNESROBERTm41b22H1651855

HOLMESANDERSONm47b22H1151960

JOHNSONVIOLAf69b22H1592770

WEBSTERGEORGIAf79b23n1381055

BRYDIESHIRLEYf46b23n1471655

COOPERWILLIAMm58b23DH1622175

EMERSONDOROTHYf69b23H1532365

KIRKLANDLARRYm57b23H1512955

HUTCHERSONFRANCISf60b24DH1452060

ANTHONYSHERMANm73bl24h2201345

EAFFORDDOROTHYf62bl24dh1961945

SMITHETHELf64b25DH158755

THOMASERNESTm43b25H1121460

DANQUAHGENEVIEVEf56b25n1401560

VIRELLAMARYf61b25H1671855

WHITAKEREDWARDm59b25H1382055

ROBESPIERREJOSEPHm59b25D1282150

LEEWILFREDm70b25n1222255

GARYCHARLOTTEf46b25H2173760

FORDREATHAf76b26n126860

WILTSHIRELIONELm72b26n1501250

BYRDJOSEPHINEf75b26H2001765

DAVISROBERTm38b26H1222055

KEYWILLIE MAEf78b26H1542355

WILLIAMSKATHLEENf51b26n1602560

JOYNERMARYf68b26H2093960

HURDERHARRYm48bl26h1652630

DAVISTHEODOREm64bl26h1712245

FREEMANVIRGINIAf60b27HO1631455

REEDJOHNNIEm65b27O1261865

BEALCHARLESm57b27HO1532060

AUSTONBETTYf58b27HO1872050

DEBERRYLEWISm63b27HO1602260

FRIENDERNESTm72b27DHO1602565

ARRINGTONMARTHAf55bl27ho1272330

JOHNSONJOHNNYm48bl27o1722020

CLEMONSVANESTERm44b28O140950

BEGONCURDYM42b28HO1612065

KELLERNETTIEf61b28HO1502960

PALARCHEWSSTEPHENm68bl28ho158540

ERAZOGLADYSf41b29DO113850

BOISSELLEMATILDAf51b29O1681660

CELESTERMAGGIEf57b29DO1782070

SMITHVICTORIAf50b29HO1602355

LOCKHARTMYRNAf55b29HO1223060

LITTLEWILLIAMm64bl29ho1502240

ARTISWALTERm34bl29o1212235

REYNOLDSCLINTONM75bl29o1591630

BROWNJ.W.m75b30HO1701070

DIXONDORoYf59b30HO1501265

BROWNEARNESTm54b30DO1461855

DURHAMBLACKSCLARENCEm63b30HO1061865

MCCLOUDNELLIEf66b30DO1842455

JOHNSONHELENf58bl30ho133930

SLATERBEVERLYf50b31HO1671655

HOLDERANNAf71bl31ho1501730

DAVISWALTERm52bl31dho2022725

ST. PIERREMICHAELm51b32HO179175

JEFFERSONULYSSESm73b32HO1451560

SIMMONSCLARISEF43b32ho1421950

WILLIAMSELAINEf45b32HO1582350

MAYFIELDWILLISM68b32HO1732755

WILLIAMSFLORENCEF70b32HO1602765

MCCUTCHENHATTIEf54b32HO1643155

CLARKDAVIDm58bl32dho1884445

HARRINGTONVERGIEf59b33O1241065

COOPERJOSEPHm42b33O1441155

DAVISBETTYf46b33DHO1512180

QUINTYNERACHELf72b33ho1502260

BALOMOSSIEf70b33HO1502760

DANIELSCASSANDRAf57b33O1592755

ROYSTERDUBAf81bl33ho1974130

BENNETTAKBARm36bl33ho1373035

JOHNSONCASANDRAF49b34HO2081465

LUCASEARLm60bl34ho1193725

TERRYWILLIEm80bl34ho1752440

PEAKMARYf68B35H1611560

TILLERYWILLIEm50b35HO1501255

BROXTONLEROYm58b35HO1201350

HOLMESFLORENCEf50b35O1201755

SMITHBARBARAf75b35HO1751975

MCCOMBCARRIEf67bl35ho1401440

PARKERALLENm57bl35ho1392030

CRAWFORDRALPHm57bl35ho1702645

ORREVAf62bl35o1172020

ROBINSONDELVENEm54b36O1411355

JOHNSONTHOMASM56b36DHO1562160

MURPHYDENISEf40b36DO1532255

EVANSBEVERLYf36b36HO1832860

EVANSROSEMARYf45bl36ho1602045

JONESKEVINm39bl36o1243520

COOPERJENNEHm66b37HO1361375

COLEMANWYLIEm62b37DHO1912860

MARTINLUCILLEf72b37DHO1602860

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58.525423728828.813559322146.338983050817.457627118654.8983050847

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SYSTOLIC PRESSURE (mmHg)

DIASTOLIC PRESSURE (mmHg)

RELATIONSHIP OF SYSTOLIC AND DIASTOLIC PRESSURE

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BMI (Kg/M2)

LV DIASTOLIC PRESSURE (mmHg)

RELATIONSHIP BETWEEN BMI AND LV DIASTOLIC PRESSURE

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LV SYSTOLIC PRESSURE

LV DIASTOLIC PRESSURE

RELATIONSHIP OF LV SYSTOLIC AND DIASTOLIC PRESSURE IN HYPERTENSIVE PATIENTS

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BMI (Kg/m2)

LV DIASTOLIC PRESSURE (mmHg)

RELATIONSHIP BETWEEN BMI AND LV DIASTOLIC PRESSURE IN OBESE PATIENTS

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BMI and SYS BP

SYSTOLIC PRESSURE

BMI

BMI and SYSTOLIC PRESSURE

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QUARTILES / BMI

Systolic Pressure

BMI and SYSTOLIC PRESSURE

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EXERCISE RESPONSE IN DIASTOLIC DYSFUNCTION

ACUTE TREATMENT OF DIASTOLIC HEART FAILURE Reduce intravascular volume carefully Morphine, diuretic, NTG Control Systolic BP in obvious hypertensive stateMorphine, diuretic, NTG, ACE inhibitors, betablocker Treat any ischemia NTG, anti-thrombotic Rx, if indicatedControl ventricular heart rateBeta blocker, Ca++ channel blocker

CHRONIC TREATMENT OF DIASTOLIC HEART FAILUREStandard management of underlying disorder(s)

In Hypertrophic and/or fibrotic disorders, including hypertension, Diabetes and Obesity, consider ACE inhibitors, ARBs, Spironalactone & beta-blocker to promote regression of LV mass and prevention of further fibrosis.

Greater emphasis on maintaining sinus rhythm in patients with paroxysmal atrial fibrillation

RECURRENT PULMONARY EDEMARx: SURGICAL INTERVENTION1985

DIASTOLIC DYSFUNCTION AND OUTCOMESETARO et al 1992; AJC52 pts WITH CHF & INTACT SYSTOLIC FUNCTIONF/U 7 YRS50% CAD; 31% HTNMEAN AGE = 71COHN et al 1990; CIRC83 ptsF/U 5 YRS27% CAD; 53% HTNBROGAN et al 1992;AJM51 ptsF/U 6 YRSNO CAD

FRAMINGHAM STUDYVARSAN JACC 199980% CAD80% CAD25% CAD

PROGNOSIS OF DIASTOLIC DYSFUNCTIONNOMAL CORONARY ARTERIES BRADY & DWYER 2006 Clin Card

SUMMARY

Diastolic dysfunction and Diastolic Heart failure is commonIt is present in many common disorders. Beware and be skeptical of the patient with the diagnosis of asthma Its easy to treat the acute heart failure and fun too! Patients are usually ready to go home within hours and probably can.Managing the progression and chronic state is more problematic. Patients with many admissions with diastolic heart failure is a often physician failure in managing the underlying disorders.Prognosis is heavily influenced by the presence of coronary disease and the age of the patient. Cant live forever!