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Cardiovascular Disease in Women
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Stephen T. Sinatra, Sara Gottfried
Diastolic heart failure results from compliance issues or a “stiffening of heart muscle.” When the left ventricle does not relax fully, the cavity inside the heart is unable to fill properly with blood. In essence, during diastole, the filling cycle struggles and the heart is compromised. Patients may feel shortness of breath and fatigue, and some even experience chest discomfort as well as peripheral edema. Their symptoms and physical findings are similar to patients with systolic heart failure caused by a weakened heart, and their prognosis remains guarded.50,51 The connection between DD and cirrhosis of the liver52 is now receiving more attention from healthcare providers as is the more common relationship of DD to hypertension.51 Thus, DD must be on the radar of not only cardiologists but any physician caring for patients and especially women on a day-to-day basis. The mortality and morbidity caused by DD, which is also referred to as heart failure with preserved systolic function, is very similar to systolic heart failure. Estimated healthcare costs are approximately $30 billion in the United States alone; thus, DD and systolic dysfunction place a great burden on our healthcare system.53
The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
Pericardial disorders that lead to diastolic heart failure usually do so as a result of restriction of diastolic cardiac function (constrictive pericarditis). It is due to pericardial fibrosis or rarely infiltrating tumours.
Heart failure
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Diastolic heart failure occurs in around 40% of patients, and is due to abnormal filling of the ventricles. The haemodynamic and clinical consequences are similar to those of systolic heart failure. Patients with diastolic heart failure are typically elderly, female, obese, hypertensive and diabetic, and in contrast to patients with systolic heart failure, have preserved or normal left ventricular size, systolic function and ejection fraction. The diagnosis is made by finding clinical features of heart failure with normal systolic function on echocardiography, but signs of abnormal ventricular filling due to diastolic impairment.
Advances in multi-modality imaging for constrictive pericarditis and pericardial inflammation: role of imaging-guided therapy
Published in Expert Review of Cardiovascular Therapy, 2023
Tahir S Kafil, Tom Kai Ming Wang, Ankit Agrawal, Muhammad Majid, Alveena B Syed, Erika Hutt, Ben Alencherry, Joshua A Cohen, Sachin Kumar, Agam Bansal, Brian P Griffin, Allan L Klein
If constriction begins to develop or has established, the compliance of the pericardium will decrease due to fibrosis, calcification, and adhesions of the parietal and visceral layers [3]. On pathology, this appears as nonspecific fibrocalcific thickening [4]. This sets a narrow limit in which the right ventricle may expand and limits the filling of the heart. Due to this, with inspiration when normally there should be increased venous return to the right atrium and right ventricle, a compliant pericardium is no longer found, so the right ventricular expansion must occur toward the left ventricle leading to a shifting in the interventricular septum to the left on inspiration [3]. This is called ventricular interdependence. The result is elevated ventricular filling pressures and can lead to diastolic heart failure. On invasive cardiac catheterization, early rapid filling, equalization of end-diastolic pressures, and inspiratory reduction in LV pressure and increase in RV pressures are seen [11–13]. As constriction becomes more significant, ventricular volumes and cardiac output further reduces. This can also lead to myocardial atrophy and fibrosis, contributing to the cardiac dysfunction and recurrent heart failure [4].
The challenges of an aging tetralogy of Fallot population
Published in Expert Review of Cardiovascular Therapy, 2021
Jennifer P. Woo, Doff B. McElhinney, George K. Lui
For now, diuretics are the only pharmacologic treatment for RV dysfunction in TOF, but novel therapies such as SGLT2 inhibitors may be on the horizon. They have been shown to reduce myofilament stiffness and improve diastolic dysfunction in mouse models and human myocardial tissue [147]. Two ongoing clinical trials (the EMPEROR-Preserved trial and the DELIVER trial) are evaluating the effects of SGLT2 inhibitors in patients with heart failure with a preserved ejection fraction. Very few drugs have been shown to be beneficial in the treatment of diastolic heart failure, so if the positive signal of SGLT-2 inhibitors on myocardial relaxation demonstrated in mouse models truly translates into clinical practice, then it could potentially be applicable to RV diastolic dysfunction. Focused studies will be needed to explore the safety profile and clinical effects of SGLT2 inhibitors in adults with TOF. Similarly, randomized placebo-controlled trials are needed to study the potential therapeutic role of ARNIs and vericiguat in patients with CHD.
AL type cardiac amyloidosis: a devastating fatal disease
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Adeel Nasrullah, Anam Javed, Thejus T Jayakrishnan, Aaron Brumbaugh, Ariel Sandhu, Brent Hardman
Clinical presentation of AL type cardiac amyloidosis is varied based on the involved site. Fatigue and weakness are the most common presenting symptoms. Restrictive cardiomyopathy presents with signs and symptoms of diastolic heart failure and decreased exercise tolerance. With progression of the disease, atrial dilation occurs, which predisposes patients to atrial fibrillation and further sequelae of clot formation and systemic embolization. Cardiac conduction may be disrupted by amyloid deposition, often causing a variety of heart blocks. Soft tissue involvement has been seen as periorbital ecchymosis and macroglossia in 12.5% and 27.2%, respectively [7]. Renal AL amyloid can cause myeloma kidney and nephrotic syndrome. With underlying kidney disease, the patient may develop progressive renal failure requiring renal replacement therapy, as seen in the present case. Similar deposits in the liver and peripheral nerves can present as hepatomegaly, transaminitis, and peripheral neuropathy, respectively.