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Diastolic Heart Failure

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. Introduction.

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Diastolic Heart Failure

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

  6. PathophysiologyIncrease Passive Stiffness • Diffuse fibrosis • Post-infarct scarring • Myocyte hypertrophy • Infiltrative (amyloidosis, hemochromatosis, Fabry´s disease)

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

  8. PathophysiologyEndocadial, Pericardial Disorders

  9. PathophysiologyMicrovascular Flow,Myocardial Turgor • Capillary compression • Venouse engorgement

  10. PathophysiologyMicrovascular Flow,Myocardial Turgor

  11. PathophysiologyNeurohormonal Regulation, Other • Upregulated renin-angiotensin system • Volume overload of the contralatetal ventricle • Extrinsic compression by tumor

  12. 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.

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

  14. Pathology

  15. Clinical Signs and Symptoms

  16. Evidence of Abnormal left Ventricular Relaxation • LVdP/dtmin<1100 mmHg • IVRT<30y>92 ms, IVRT30–50y>100 ms, IVRT>50y>105 msand/or Ù>48 ms • LVEDP>16 mmHg or mean PCW>12 mmHg • PV A Flow >35 cm . s"1 • b>0·27and/or b*>16

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

  18. Management of DHF

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

  20. Conclusion Until further evidence isavailable from randomized therapeutictrials, clinicians should focus on a fewgeneral principles in the treatment ofDHF: Reduce volume overload Slowthe heart rate Control hypertension, Relieve myocardial ischemia.

  21. FUNDACION FAVALORO INSTITUTO DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR Carmen B. Gomez MD Eugene Yevstratov MD http://myprofile.cos.com/eugenefox

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