Diastolic Heart Failure

Susan C. Brozena, M.D., F.A.C.C., F.A.H.A
Disclosures		Relationship: Yes Grants/Research Support: Wyeth/Pfizer and Medtronics

Mariell L. Jessup, M.D., F.A.C.C.
Disclosures		Relationship: Yes Honorarium: Advisory Board Member for Medtronics, Acorn, Cardiomems and Ventracor

The Planners of this activity have no relationships to disclose.

Mariell Jessup, MD, is a professor of medicine at the University of Pennsylvania and medical director of the heart failure/transplant program at the University of Pennsylvania Health System. Dr. Jessup wishes to reveal that she receives research support from Guident and serves as a consultant to GSK, Medtronics, ACORN, and SCIOS.

Susan C. Brozena, MD, is an associate professor of medicine at the University of Pennsylvania in Philadelphia, PA. Dr. Brozena wishes to reveal that she is on the Speaker's Bureau for GSK and serves as Principal Investigator for studies sponsored by Medtronics and Wyeth.

This lecture and the post-test is worth 1.5 credit hours.

Here, they discuss the causes, pathophysiology, and treatment options for diastolic heart failure. The authors define diastole and its four phases, and note that hypertrophy causes abnormalities in the heart's diastolic properties. Aging is a paramount factor in the prevalence and prognosis of diastolic heart failure, with some abnormal diastolic filling characteristics present in all patients over 70. Other disease processes in the aged, such as hypertension, hypertrophic cardiomyopathy, and chronic renal disease can contribute to diastolic filling abnormalities.

Normal diastole requires normal release of calcium from troponin-C and several other factors shown in illustrations. The lecture touches on the many forces that act on the heart, including atrial pressure, aortic pressures, and end diastolic pressures.

A study of 20,000 patients with heart failure showed diastolic heart failure present in 35%. While reaching a diagnosis of diastolic heart failure is elusive, the authors describe some possible criteria, including breathlessness, pulmonary edema, in association with an LVEF over 50%. Routine transthoracic echocardiography in diastolic heart failure is described as the most clinically useful way to assess diastolic function. But, say the authors, a history and physical showing dyspnea on exertion, paroxysmal nocturnal dyspnea and gallop rhythms are clinical indicators of diastolic heart failure. More recently, brain-natriuretic peptide, has been used to detect failure in patients with diastolic abnormalities.