Systolic vs. Diastolic Heart Failure
What is the difference between systolic and diastolic heart failure in terms of pathophysiology clinical presentation and management?, How does ejection fraction help differentiate the two conditions, and why do treatment strategies vary based on this classification?
Differences Between Systolic and Diastolic Heart Failure
Pathophysiology
- Systolic Heart Failure (SHF):
- Definition: Characterized by a reduced ability of the heart to contract and pump blood effectively.
- Ejection Fraction: Typically defined by an ejection fraction (EF) of less than 40%. This indicates that a significant portion of blood remains in the ventricles after contraction.
- Causes: Common causes include ischemic heart disease, myocardial infarction, and dilated cardiomyopathy.
- Diastolic Heart Failure (DHF):
- Definition: The heart’s ventricles cannot relax properly, leading to impaired filling during diastole.
- Ejection Fraction: Usually has a preserved ejection fraction (EF of 50% or more). The issue lies in the heart’s inability to fill adequately, not in its ability to contract.
- Causes: Often associated with hypertension, left ventricular hypertrophy, and restrictive cardiomyopathy.
Clinical Presentation
- Systolic Heart Failure:
- Symptoms often include fatigue, shortness of breath (especially during exertion), and signs of fluid overload (e.g., edema, pulmonary congestion).
- Patients may present with low blood pressure and reduced exercise tolerance.
- Diastolic Heart Failure:
- Symptoms can include similar manifestations as SHF, such as shortness of breath and fatigue, but often with less pronounced fluid overload.
- Patients may experience episodes of acute heart failure or pulmonary congestion, especially during physical activity or when lying flat.
Management
- Systolic Heart Failure:
- Medications: Typically treated with ACE inhibitors, beta-blockers, diuretics, and aldosterone antagonists to improve symptoms and reduce mortality.
- Devices: Some patients may benefit from implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy (CRT).
- Lifestyle Modifications: Recommendations include dietary changes, exercise, and monitoring of fluid intake.
- Diastolic Heart Failure:
- Medications: Focus primarily on managing underlying conditions APA