Diastolic dysfunction and heart failure: causes and treatment options.
Diastolic dysfunction is the underlying problem in one third of patients with heart failure, but it is still not well understood. Carefully excluding other causes of heart failure and recognizing indicators of diastolic dysfunction on invasive and noninvasive tests are important in establishing the diagnosis and in guiding therapy. Left ventricular relaxation and stiffness and left atrial function are the most important factors acting together to maintain adequate cardiac output under normal filling pressure. Echocardiography is the most important tool for the diagnosis of diastolic heart dysfunction. It is portable, safe, and excludes other causes of heart failure, such as valvular disease. Diuretics can be used to reduce volume overload, but caution is advised, as aggressive diuresis decreases stroke volume more in diastolic dysfunction than in systolic dysfunction.
Garcia
M J
MJ
Department of Cardiology, Cleveland Clinic, USA. garciam@ccf.org
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002302:Cardiac Output; D009202:Cardiomyopathies / Q000150:complications*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000150:complications*; D003971:Diastole; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology
D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D004232:Diuretics