Diastolic dysfunction causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Causes
- 1- Impaired extent and/or speed of myocardial relaxation:
- Myocardial relaxation is an ATP dependent process regulated by the rate of reuptake of cytoplasmic calcium into the sarcoplasmic reticulum.
- Low concentration of calcium, as seen in ischemia, is associated with a slowed down myocardial relaxation.
- 2- Increased myocardial stiffness:
- Myocardial stiffness can be secondary to cardiac muscle hypertrophy (for example as seen in hypertension)
- Myocardial stiffness can be the result of infiltrative diseases like amyloidosis.
- Scarred heart muscle,occurring after a heart attack, scars are relatively stiff.
- Diabetes can be a cause of cardiac stiffness as a result of glycosylation of the heart muscle.
- 3- Extrinsic constraints:
- Extrinsic constraints can be seen in pericardial compression
- 4- Chamber dilatation:
- Severe systolic dysfunction that has led to ventricular dilation can be associated with diastolic dysfunction.When the ventricle has been stretched to a certain point, any further attempt to stretch it more, as by blood trying to enter it from the left atrium, meets with increased resistance and thus decrease compliance.
- 5- Miscelleneous:
- In mitral stenosis, blood cannot readily flow out from the left atrium into the left ventricle since the valve between those two heart chambers is blocked which causes the blood to back up into the left atrium and, eventually, the lungs. Pulmonary edema may result.
- Diastolic dysunction secondary to mitral stenosis is especially when the heart rate is elevated, as occurs in exercise and pregnancy. Thus, there will be insufficient time for blood to traverse the narrowed passageway (i.e. mitral valve) between the left atrium and left ventricle.[1]
References
- ↑ Mann D.L., Chakinala M. (2012). Chapter 234. Heart Failure and Cor Pulmonale. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.