Women and Heart Disease
Stephen T. Sinatra, Mark C. Houston in Nutritional and Integrative Strategies in Cardiovascular Medicine, 2015
Diastolic heart failure is the accumulation of fluid in the body resulting from compliance issues of the left ventricle or a “stiffening of the heart muscle.” When the myocardium does not relax fully, the cavity inside the heart remains compromised and is unable to fill properly. In essence, during diastole the filling cycle struggles. Therefore, patients may feel shortness of breath and may complain of chest pain, fatigue, and even leg swelling. Their symptoms and physical findings are similar with patients with systolic heart failure caused by a weakened heart13 (often referred to as heart failure with impaired systolic function), and their prognosis in most cases is poor.13,14 The morbidity and mortality caused by diastolic heart failure, again, often referred to as heart failure with well-preserved systolic function, is very similar to systolic heart failure. The estimated health-care cost is $30 billion dollars in the United States for 2010.15 Thus, diastolic heart failure and systolic dysfunction places a great burden on the health-care system in the United States.
Cardiovascular Disease in Women
Stephen T. Sinatra, Mark C. Houston in Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
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
Heart failure
Clive Handler, Gerry Coghlan, Nick Brown in Management of Cardiac Problems in Primary Care, 2018
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.
The a´ velocity in the tissue Doppler predicts S/D ratio <1 in patients with a normal ejection fraction
Published in Scandinavian Cardiovascular Journal, 2018
Benny Johansson, Fredrik Lundin, Rolf Tegeback, Leif Bojö
An isolated diastolic heart failure is reported in up to 50% of the patients with heart failure and is associated with a morbidity and mortality similar to systolic heart failure [16–18]. Studies have shown that in patients with a preserved systolic function, the presence of a dominant diastolic component in the pulmonary venous flow (S/D ratio <1) and a decreased left atrial contractile function can identify patients with an impaired clinical short and long-term outcome [1–5]. Furthermore an isolated diastolic heart failure in patients with significant coronary artery disease could be explained by an increased diastolic stiffness due to an increased amount of both collagen 1 and 3 and a changed regulation of the three different titin springs (tandem Ig segment, PEVK and N2B(A) bus) leading to a high left ventricular end-diastolic filling pressure [6]. The current ASE/EACVI guidelines from 2016 [7,8] do not include the S/D ratio or any direct parameter reflecting the LA contractile status in their criteria of evaluating a diastolic dysfunction or an increased LV filling pressure in patients with a normal ejection fraction. The recently published invasive multicenter Euro-Filling study [19] could not establish any significant correlation between the non-invasive echo estimates of LVFP compared to invasive measurements of left ventricular end diastolic pressure (LVEDP). In this study where 75% of the patients had a normal ejection fraction, only a weak correlation was found between the Doppler and the tissue-Doppler parameters and invasive LVEDP.
Mechanisms, diagnosis, and treatment of heart failure with preserved ejection fraction and diastolic dysfunction
Published in Expert Review of Cardiovascular Therapy, 2018
Gilman D. Plitt, Jordan T. Spring, Michael J. Moulton, Devendra K. Agrawal
Heart failure is a common but complex syndrome, caused by a wide variety of etiologies. Historically, heart failure was primarily classified by the type of cardiac dysfunction present, either systolic or diastolic heart failure [1]. While this is a useful theoretical categorization emphasizing whether the primary problem is defective pumping or filling, in clinical practice systolic dysfunction and diastolic dysfunction (DD) are rarely isolated and often both contribute to the clinical picture [2]. More recently, heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) have become the preferred terms for describing heart failure, relying solely on the calculated ejection fraction (EF) [1]. This terminology allows for easier and reproducible classification of heart failure, without misrepresenting the complex underlying cause. A challenge with this definition has been establishing a consistent cut-off between preserved and reduced EF. While an EF of 50% is the most common cut off for HFpEF, some sources and clinical trials have used 40%, blurring the data between the two groups [3]. In addition, the new classification of heart failure with mid-range ejection fraction (HFmrEF) with an EF between 40% and 50% further adds to the confusion [4]. After clinically determining the EF, evaluation of systolic and diastolic function is crucial to the work up of both HFrEF and HFpEF in order to determine the likely etiology as well as provide valuable information about the disease process.
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].
Related Knowledge Centers
- Cardiac Catheterization
- Diabetes
- Echocardiography
- Obstructive Sleep Apnea
- Smoking
- Diastole
- Ejection Fraction
- Hypertension
- Hyperlipidemia
- Heart Failure