Related Experiment Video
Updated: Oct 8, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Congestive heart failure in hypertensive patients with normal systolic function and dynamic left ventricular outflow
A Sgreccia1, G Morabito, A Gurgo Di Castelmenardo
1Istituto di I Clinica Medica, Università La Sapienza, Viale del Policlinico--00161 Rome, Italy.
Insights
Hypertensive patients with heart failure unresponsive to standard treatments may have diastolic heart failure or dynamic left ventricular obstruction. Early echocardiography is crucial for diagnosis and effective treatment with calcium channel blockers or beta-blockers.
Area of Science:
- Cardiology
- Internal Medicine
- Heart Failure Research
Background:
- Congestive heart failure in hypertensive patients with left ventricular hypertrophy and normal systolic function can be refractory to conventional therapies.
- Standard treatments include digoxin, diuretics, and vasodilators.
Purpose of the Study:
- To investigate the underlying cause of congestive heart failure in patients with hypertension and left ventricular hypertrophy unresponsive to conventional therapy.
- To evaluate the effectiveness of alternative drug therapies.
Main Methods:
- Studied 8 patients (mean age 69 years) with NYHA class IV heart failure despite conventional treatment.
- Performed comprehensive clinical evaluation, blood tests, imaging (chest roentgenogram, echocardiography), and ECG.
- Assessed left ventricular function and outflow obstruction via echocardiography.
Main Results:
- All patients exhibited increased left ventricular wall thickness, normal cavity size, and normal/supernormal systolic function.
- Left ventricular systolic dynamic obstruction was present in all patients, with a mean peak gradient of 83 mmHg.
- Switching to calcium channel antagonists or beta-blockers after discontinuing nitrates, digoxin, and diuretics led to rapid clinical improvement and resolution of obstruction.
Conclusions:
- Diastolic heart failure and/or dynamic left ventricular obstruction should be suspected in hypertensive patients with left ventricular hypertrophy and ECG signs when conventional therapy fails.
- Early echocardiographic assessment is recommended for accurate diagnosis and management.
- Alternative therapies like calcium channel blockers and beta-blockers are effective in managing this specific heart failure subtype.
Background:
Hypertensive patients with left ventricular hypertrophy and normal systolic function can develop congestive heart failure refractory to conventional drug therapy with digoxin, diuretic, and vasodilators.
Methods:
We studied 8 patients with a history of systemic hypertension (6 females and 2 males, mean age 69+/-6 years), affected by New York Heart Association (NYHA) class IV congestive heart failure notwithstanding conventional drug therapy with digoxin, diuretic, and vasodilators. After clinical history and physical examination, blood chemistry including cardiac enzymes, arterial blood gases, chest roentgenogram, standard 12-lead ECG, and complete echocardiographic study were performed in all patients.
Results:
In all cases, a left ventricle with increased wall thickness, normal cavity size, and normal or supernormal systolic function was shown. All patients had left ventricular systolic dynamic obstruction, with peak gradient between 36 and 130 mmHg (mean 83+/-31). After having stopped treatment with nitrates, digoxin, and diuretics, drug therapy with calcium channel antagonists or beta-blockers was started, and rapid clinical improvement with disappearance of left ventricular outflow obstruction was observed.
Conclusions:
Sometimes, a distinction between several forms of heart failure is clinically impossible. However, when conventional therapy is not effective in patients with longstanding history of systemic hypertension and ECG signs of left ventricular hypertrophy, diastolic heart failure and/or dynamic left ventricular obstruction should be suspected. Thus, an early echocardiographic study should be performed.
Related Concept Videos
01:29Heart Failure II: Pathophysiology
01:17Pathophysiology of Heart Failure
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...
01:26Heart Failure III: Clinical Manifestations
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:27Heart Failure I: Introduction