Systolic dysfunction

Systolic dysfunction

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Overview

Left ventricular systolic dysfunction is the condition where the left ventricle can only manage to eject less than 40% (occasionally less than 35%) of the blood in it, with each contraction. The term is used when the echocardiogram shows this but the patient isn’t in overt heart failure.

Treatment

Non-pharmacologic treatment

• Exercise
• Dietary changes
• Operative therapy: Surgery for underlying valvular heart diseases

Pharmacotherapy

For patients with systolic dysfunction (EF < 40%) who have no contraindications:

• ACE (angiotensin-converting enzyme) inhibitors for all patients.
• Beta blockers for all patients except those who are hemodynamically unstable, or those who have rest dyspnea with signs of congestion.
• Aldosterone antagonist (low dose) for patients with rest dyspnea or with a history of rest dyspnea or for symptomatic patients who have suffered a recent myocardial infarction.
• Isorbide dinitrates-hydralazine combination for symptomatic heart failure patients who are African-American.
• ARBs (angiotensin receptor blockers) as a substitute for patients intolerant of ACE inhibitors.
• Digoxin only for patients who remain symptomatic despite diuretics, ACE inhibitors and beta blockers or for those in atrial fibrillation.
• Diuretics for symptomatic patients to maintain appropriate fluid balance.

Device based therapy

• Implantable defibrillators considered for prophylaxis against sudden cardiac death in patients with EF ≤ 35%.
• Bi-ventricular pacemakers considered for patients requiring defibrillators who have symptomatic HF and QRS durations ≥ 120 msec.

Additional Readings

• Shekelle P, Rich M, Morton S, et al. Pharmacologic Management of Heart Failure and Left Ventricular Systolic Dysfunction: Effect in Female, Black, and Diabetic Patients, and Cost-Effectiveness. Evidence Report/Technology Assessment No. 82 (Prepared by the Southern California-RAND Evidence-based Practice Center under Contract No 290-97-0001). AHRQ Publication No. 03-E045. Rockville, MD: Agency for Healthcare Research and Quality. July 2003
• McAlister FA, Ezekowitz J, Dryden DM, Hooton N, Vandermeer B, Friesen C, Spooner C, Rowe BH. Cardiac Resynchronization Therapy and Implantable Cardiac Defibrillators in Left Ventricular Systolic Dysfunction. Evidence Report/Technology Assessment No. 152 (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290-02-0023). AHRQ Publication No. 07-E009. Rockville, MD: Agency for Healthcare Research and Quality. June 2007.

See Also

• Heart failure
• Diastolic dysfunction

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