Diastolic Heart Failure In The Western Medical Progress

Thirty percent to fourty percent of patients with chronic heart failure have normal or relatively normal left ventricular ejections fractions. Now these patients have beensystematically excluded from heart failure, named diastolic heart failure (DHF). DHF occurs when signs and symptoms of heart failure are present but left ventricular systolic function is preserved (i.e. ejection fraction greater than 45 percent). Inmost, left ventricular diastolicdysfunction (DD) plays a major role in the genesis of DHF. It is characterized by a stiff left ventricle with decreased compliance and impaired relaxation, which leads to increased end diastolic pressure. The use of Doppler echocardiography (transmitral inflow and pulmonary venous flow) and the new ultrasound tools has to be encouraged for diagnosis of DD(trans-mitral-valve blood flow , pulmonary-vein-vale blood flow, isovolumic relaxation time et). With early diagnosis and proper management the prognosis of diastolic dysfunction is important, Like systolic heart failure (SHF), DHF is associated with significant morbidity, mortality, few clinical trials focusing on isolated DHF have been completed. Much of the treatment of DHF is based on current concepts of the pathophysiology of DHF, small clinical studies, and experience. Pharmacologic treatment of diastolic heart failure should focus on normalizing blood pressure, promoting regression of left ventricular hypertrophy, avoiding tachycardia , treating symptoms of congestion , and maintaining normal atrial contraction. Diuretic therapy is the mainstay of treatment for preventing pulmonary congestion, while beta blockers appear to be useful in preventing tachycardia and thereby prolonging left ventricular diastolic filling time. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may be beneficial in patients with diastolic dysfunction, especially those with hypertension.