diastolic dysfunction and heart failure physiology, historical features and clinical perspective
DESCRIPTION
DIASTOLIC DYSFUNCTION AND HEART FAILURE PHYSIOLOGY, HISTORICAL FEATURES AND CLINICAL PERSPECTIVE. Medicine Resident Rounds September 28, 2007 Jacobi Hospital. TERMINOLOGY. Diastolic dysfunction Alteration in active or passive relaxation of the LV Diastolic heart failure - PowerPoint PPT PresentationTRANSCRIPT
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DIASTOLIC DYSFUNCTION AND HEART FAILURE PHYSIOLOGY, HISTORICAL FEATURES AND CLINICAL PERSPECTIVEMedicine Resident RoundsSeptember 28, 2007Jacobi Hospital
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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.
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ISOVOLUMIC (EARLY) RELAXATIONENERGY DEPENDENT
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Phases of diastole
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Elevated Left Ventricular Diastolic Pressure Causes Pulmonary Congestion
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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
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SPONTANEOUS ANGINA EFFECT ON SYSTOLIC & DIASTOLIC PRESSURE
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LV DIASTOLIC PRESSURE CHANGESDURING EXERCISE INDUCED ANGINA50--- 50---
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CHANGES IN LV DIASTOLIC PRESSURE AND VOLUME DIURING ANGINA -- INDUCED BY ATRIAL PACING DWYER CIRC 1970
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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
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LV DIASTOLIC DISTENSIBILITY
Stiffness- Compliance- Distensibility are best quantified by the LV pressure / volume relationship
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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
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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)
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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
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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
Page &P
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
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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
Sheet6
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BMI and SYS BP
SYSTOLIC PRESSURE
BMI
BMI and SYSTOLIC PRESSURE
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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
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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
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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
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RECURRENT PULMONARY EDEMARx: SURGICAL INTERVENTION1985
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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
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FRAMINGHAM STUDYVARSAN JACC 199980% CAD80% CAD25% CAD
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PROGNOSIS OF DIASTOLIC DYSFUNCTIONNOMAL CORONARY ARTERIES BRADY & DWYER 2006 Clin Card
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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!