Diastolic Heart Failure

Published

Can someone explain to me how my patient has diastolic heart failure with an EF of 55%? I understand that the left ventricle is not relaxing properly to allow correct blood flow but how can this occur and still produce a good EF? I have googled this so no answers like that please.

Up Vote Up Vote ×
Specializes in Critical Care.

see if this helps:

patients with systolic heart failure typically have a low lvef (usually less than 40 to 45%), a dilated left ventricular cavity, and a reduced cardiac output because of diminished contractility of the myocardium. in contrast, patients with diastolic heart failure have a normal lvef and normal contractility, but filling of the heart is impaired by a variety of pathophysiologic abnormalities, and salt and water homeostasis is abnormal. this syndrome is increasingly referred to as heart failure with preserved ejection fraction.

Up Vote Up Vote ×

But how can there be a decrease in the amount of filling of the ventricles and still be a normal EF?

Up Vote Up Vote ×
Specializes in Critical Care.

see if you can pull up this link:

http://www.uptodate.com/contents/pathophysiology-of-diastolic-heart-failure?source=see_link

If not, you could sign into medscape and search for pathophysiology of diastolic heart failure. It's a bit much information to try to type in here.

Let me see if I can put this simply: as in the above stated definition, the heart isn't able to fill properly due to a variety of reasons. Don't confuse filling properties with ejection fraction. If the myocardial tissues aren't able to relax, it can impair the ability of the left ventricle to fill. The heart can still contract but it can't relax enough to get properly filled. Some common characteristics are:

The major abnormalities in LV diastolic function that contribute to the development of DHF include:

  • Slowed, delayed and incomplete myocardial relaxation
  • Impaired rate and extent of LV filling
  • Shift of filling from early to late diastole
  • Decreased early diastolic suction/recoil
  • Increased LA pressure during the early filling
  • Increased passive stiffness and decreased distensibility of the LV
  • Impaired ability to augment cardiac output during exercise
  • Impaired ability to augment relaxation during exercise
  • Inability to utilize the Frank-Starling mechanism during exercise
  • Increased diastolic LV, LA, pulmonary venous pressure at rest and/or during exercise.

I'm really not trying to blow you off here. But this is a difficult concept to study and an even more difficult topic treat. One of the heart failure specialists I work with describes treating diastolic heart failure as more of an art than a science as there are not many studies showing how to treat this type of heart failure. There is a ton of data on systolic heart failure.

Ok, just found you a great article in Medscape on Heart Failure:

http://emedicine.medscape.com/article/163062-overview

You have to have a log in to access but signing up is free. I highly recommend it. Heart failure is a complex topic to study, I"ve been working with it for over 10 years now and I still learn something new every day. Good luck, hope this helps.

Up Vote Up Vote ×
Specializes in Critical Care.

Just thought I'd better apologize, I'm pretty tired tonight. I love teaching about heartfailure but I can't get my thoughts organized tonight which is why I put those links in there. Just one of those nights where I can't get my thoughts out worth a darn. Sorry about that.

Up Vote Up Vote ×

Do some research on left ventricular hypertrophy. Causes, signs and symptoms, maybe an alternate indicative cardiac value?

Up Vote Up Vote ×
+ Join the Discussion