Congestive Heart Failure 4

What is Diastolic Heart Failure?

The left ventricle (LV) or major pumping chamber of the heart empties during the phase of the heart cycle known as systole. The filling process of the LV is known as diastole. Traditionally, CHF usually refers to failure or weakness of the pumping or systolic action of the heart. However, CHF can also occur in patients who have well preserved systolic function but have problems with diastole or filling of the LV.

The walls of the LV are made up of fairly "elastic" muscle which stretches when it is filled up with blood returned by the body. The LV becomes stiffer and less elastic when it is severely thickened as a result of long standing, uncontrolled high blood pressure or certain types of heart disease such as hypertrophic cardiomyopathy. Stiffness of the LV can also be caused by a disease known as restrictive cardiomyopathy.

With increased stiffness of its walls, the LV requires a higher volume of blood to stretch adequately. Less blood will not be able to stretch and fill the LV.

The high pressure is reflected back to the lungs, the right ventricle, and the body. As the pressure rises, the lungs, legs, etc., become congested in a manner similar to that of CHF caused by weakness of the heart muscle. This is known as diastolic heart failure and can be seen even when the pumping ability of the heart is well preserved.

How is CHF diagnosed?

A diagnosis of CHF is first suspected when the patient provides a medical history and complains about fatigue, shortness of breath, swelling and weight gain. Physical examination by the physician helps to strengthen the suspicion or even confirm the diagnosis. At this time, the physician will usually order an EKG (to determine if there is evidence of a prior heart attack, signs of increased wall thickness, irregular heart beats, etc.). A chest x-ray will show if the heart is enlarged and whether or not the lungs are congested or filled with fluid. An echocardiogram is an extremely important test that helps determine the size, thickness and function of the various heart chambers and valves. It also helps estimate pressure within the lungs and determines whether or not the patient’s volume of blood is excessive. Based upon the above evaluation, the physician may order a Holter monitor if irregular heart beats are suspected or seen, a stress test (regular, echocardiographic, nuclear or chemical) if coronary disease is suspected, or even recommend cardiac catheterization.

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