[Cardiac insufficiency with normal systolic function. Physiopathology and therapeutic implications]

Heart failure is a very common disease with ageing of the population and represents the leading cause of admission to hospital. The consequences of ageing, the frequency of ischaemic heart disease and hypertension predispose to the development of heart failure. Ageing promotes arterial, aortic and cardiac remodelling, resulting in an increase of cardiac work, myocardial hypertrophy and progressive alteration of ventricular function. The elderly heart has a reduced compliance, and loses its preload reserve and its chronotropic reserve. It adapts poorly to effort, arrhythmias and loss of atrial systole. Heart failure can be atypical with neurological and pulmonary or gastrointestinal signs. Radiological examination, and especially echocardiography, are essential. There is often a very predominant alteration of diastolic function (abnormalities of relaxation and compliance). Treatment is made difficult by the presence of multi-organ disease, which reduces the safety margin of digitalis alkaloids, diuretics and ACE inhibitors. Blood digoxin, creatinine and potassium levels must be regularly monitored. Revascularization techniques should not be abandoned and aortic valve surgery, in particular, gives good results when it is not performed too late. ACE inhibitors and vasodilators are generally well tolerated.