Diastolic dysfunction
|
Diastolic dysfunction Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Diastolic dysfunction On the Web |
|
American Roentgen Ray Society Images of Diastolic dysfunction |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor in Chief: Hector Tamez [2]
Treatment
By and large, diastolic dysfunction is chronic process (except during acute ischemia - see above). When this chronic condition is well tolerated by an individual, no specific treatment may be indicated. Rather, therapy should be directed at the root cause of the stiff left ventricle with things like high blood pressure and diabetes treated appropriately. Conversely, and as noted above, diastolic dysfunction tends to be better tolerated if the atrium is able to pump blood into the ventricles in a coordinated fashion. This does not occur in atrial fibrillation where there is no coordinated atrial activity. Hence, atrial fibrillation should be treated aggressively in people with diastolic dysfunction. In the same light, and also as noted above, if the atrial fibrillation persists and is leading to a rapid heart rate, treatment must be given to slow down that rate.
At this date, the role of specific treatments for diastolic dysfunction per se is unclear. There is some evidence that calcium channel blocker drugs may be of benefit in reducing ventricular stiffness in some cases. Likewise, treatment with angiotensin converting enzyme inhibitors such as enalapril, ramipril, and many others, may be of benefit due to their effect on ventricular remodeling.
A major treatment consideration in people with diastolic dysfunction is when pulmonary edema develops. Unlike treatment of pulmonary edema occurring the setting of systolic dysfunction (where the primary problem is poor ventricular pumping as opposed to poor filling), the treatment of pulmonary edema complicating diastolic dysfunction emphasizes heart rate control (i.e. lowering it). Diuretics are often given as well. The role of afterload reduction in this setting is unknown.
References
Sources
- Owan TE, Hodge DO, Herges, RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in Prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006; 355:251-9.
- Bhatia S, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 2006; 355:260-9.