The less familiar side of heart failure: symptomatic diastolic dysfunction.
Arrange for echocardiography or radionuclide angiography within 72 hours of a heart failure exacerbation. An ejection fraction >50% in the presence of signs and symptoms of heart failure makes the diagnosis of diastolic heart failure probable. To treat associated hypertension, use angiotensin receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, calcium channel blockers, or diuretics to achieve a blood pressure goal of <130/80 mm Hg. When using beta-blockers to control heart rate, titrate doses more aggressively than would be done for systolic failure, to reach a goal of 60 to 70 bpm. Use ACE inhibitors/ARBs to decrease hospitalizations, decrease symptoms, and prevent left ventricular remodeling.
Morris
Spencer A
SA
Georgetown Hospital System, Georgetown Memorial Hospital, 606 Black River Road, Georgetown, SC 29440, USA. spenceamorris@aol.com
Van Swol
Mark
M
Udani
Bela
B
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015897:Comorbidity; D003971:Diastole; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography; D005194:Family Practice / Q000379:methods / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D004077:Digoxin