Diastolic dysfunction and congestive heart failure
1Charles A. Dana Research Institute, Boston, Massachusetts.
Insights
Diastolic heart failure involves impaired ventricular filling, often with preserved systolic function. Structural changes and relaxation abnormalities contribute to this condition, impacting heart health.
Area of Science:
- Cardiology
- Heart Failure Research
Background:
- Diastolic heart failure (DHF) is defined by increased resistance to ventricular filling.
- A significant patient group exhibits DHF with normal systolic function.
- DHF can stem from structural issues like constrictive pericarditis or fibrosis.
Purpose of the Study:
- To explore the mechanisms underlying diastolic dysfunction in heart failure.
- To investigate the role of structural and physiological factors in DHF.
- To understand the contribution of diastolic dysfunction to conditions like pulmonary edema.
Main Methods:
- Review of existing literature on diastolic heart failure.
- Analysis of structural and physiological derangements in cardiac ventricles.
- Examination of myocardial hypertrophy and its impact on diastolic function.
Main Results:
- DHF can result from extramyocardial or intramyocardial structural abnormalities.
- Impaired myocardial relaxation and inactivation are key contributors to DHF.
- Advanced myocardial hypertrophy involves structural changes and impaired relaxation, increasing diastolic inflow resistance.
Conclusions:
- Diastolic dysfunction is a critical component of heart failure, even with normal ejection fraction.
- Structural abnormalities and impaired myocardial relaxation are central to DHF.
- Understanding DHF mechanisms is crucial for managing heart failure and related complications like pulmonary edema.
Abstract:
Diastolic heart failure is characterized by increased resistance to diastolic filling of one or both cardiac ventricles. Although some degree of diastolic failure exists in most patients presenting clinically with heart failure, a substantial subset of patients have relatively pure diastolic heart failure with normal systolic function. Diastolic heart failure can be due to structural abnormalities that increase resistance to ventricular inflow, and these structural abnormalities can be extramyocardial (e.g., constrictive pericarditis and mitral stenosis) or intramyocardial (e.g., fibrosis and amyloidosis). In addition to structural abnormalities, physiological derangement of myocardial inactivation and relaxation can contribute importantly to diastolic dysfunction in patients with heart failure. There is mounting evidence that advanced myocardial hypertrophy is associated with increased resistance to ventricular diastolic inflow due to both structural alteration (increased wall thickness and altered collagen matrix) and impaired diastolic relaxation of the hypertrophied myocardium. Physiological mechanisms for impaired relaxation in advanced hypertrophy remain controversial but can include disordered function of myocardial sarcoplasmic reticulum, subendocardial ischemia, and altered adenylate cyclase function. Diastolic dysfunction can play an important role in the genesis of flash pulmonary edema seen in patients with ischemic heart disease because myocardial ischemia is associated with a decline in relaxation rate, increased resistance to early diastolic filling, and in some cases, a striking upward shift in the left ventricular diastolic pressure-volume relation.(ABSTRACT TRUNCATED AT 250 WORDS)
Related Concept Videos
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...
01:20Mitral Regurgitation I: Introduction
01:27Heart Failure I: Introduction
01:29Heart Failure II: Pathophysiology
01:30Cardiomyopathy II: Dilated Cardiomyopathy