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Congestive heart failure: systolic and diastolic function

W C Little1, R J Applegate

  • 1Bowman Gray School of Medicine, Department of Internal Medicine, Winston-Salem, NC 27157-1045.

Journal of Cardiothoracic and Vascular Anesthesia
|August 1, 1993
PubMed
Summary

Congestive heart failure arises from impaired left ventricular systolic (emptying) and diastolic (filling) function. Understanding both is crucial for diagnosing and treating this condition.

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Area of Science:

  • Cardiology
  • Heart Failure Pathophysiology

Background:

  • Congestive heart failure (CHF) is increasingly recognized as resulting from disorders in both left ventricular systolic and diastolic function.
  • Evaluating the filling and emptying characteristics of the left heart is essential for understanding hemodynamic abnormalities in CHF.

Purpose of the Study:

  • To provide a conceptual framework for classifying and understanding the pathophysiology of CHF based on systolic and diastolic dysfunction.
  • To define systolic and diastolic dysfunction and their interrelationships.

Main Methods:

  • Definition of systolic dysfunction as impaired left ventricular (LV) emptying, indicated by a decreased ejection fraction (<50%).
  • Definition of diastolic dysfunction as impaired LV filling requiring elevated pulmonary venous pressure, clinically manifesting as pulmonary congestion.

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  • Identification of causes for systolic dysfunction (impaired contractility, increased afterload, structural abnormalities) and diastolic dysfunction (obstruction, reduced distensibility, external compression).

    • Main Results:

    • Systolic dysfunction is characterized by reduced ejection fraction and can stem from myocardial issues, afterload, or structural problems.
    • Diastolic dysfunction leads to pulmonary congestion and often occurs secondary to systolic dysfunction, with dyspnea as a common symptom.
    • Diastolic dysfunction with normal systolic function can result from filling obstructions, reduced LV distensibility, or compression.

    Conclusions:

    • Both systolic and diastolic left ventricular function are critical in the development of congestive heart failure.
    • Understanding the distinct mechanisms of systolic and diastolic dysfunction is key to effective diagnosis and treatment strategies.
    • Treatment of diastolic dysfunction involves addressing underlying causes such as ischemia, improving systolic function, managing blood pressure, and reducing cardiac volume.