Diastolic Heart Failure
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Congestive heart failure due to diastolic dysfunction of the left ventricle
Management Principles
The table below is modified from a review in the New England Journal of Medicine.
| Management Principles in Diastolic Heart Failure |
| Goal |
Treatment |
| Reduce Congestive State |
Salt restriction (less than 2g Na per day), diuretics, ace-inhibitors and angiotensin blockers |
| Maintain atrial contraction to fill left ventricle |
Attempt to maintain sinus rhythm |
| If unable to maintain sinus rhythm, control heart rate response well |
Use betablockers and other drugs in combination (if necessary) to slow heart rate. If heart rate response to atrial fibrillation can not be controlled, consider AV nodal ablation and ventricular pacing |
| If in sinus rhythm, ensure there is adequate time for left ventricular filling during diastole |
Use betablockers to control or prevent tachycardia |
| Treat and prevent myocardial ischaemia |
With pharmacological and interventional therapy |
| Control Hypertension |
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| Measures with theoretical benefit |
| Promote regression of hypertrophy and prevent fibrosis |
Use ace-inhibitors, angiotensin and aldosterone blockers |
These management principles would also apply to patients with significant impairment of systolic function who also have diastolic dysfunction.
Hitesh Patel, Cardiologist
12th March, 2005
Selected references:
- Diastolic heart failure. N Eng J Med 2004;351:1097-105
- Heart failure with preserved left ventricular systolic function. J Am Coll Cardiol 2004;43:317–27
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