Isolated Diastolic Heart Failure Analysis

Systolic heart failure is characterized by enlarged ventricles that are unable to fully contract to pump enough blood into circulation to adequately perfuse tissues. The enlargement in ventricles is due to an increased end-systolic volume. If the heart is not able to sufficiently pump the expected volume of blood with each contraction, which in a normal healthy heart is 50-60%, there will be a residual volume left in the heart after every pump (Heart Healthy Women, 2012). With the next period of filling, the heart will receive the same amount of blood volume from the atria combined with that residual volume from the previous contraction. This causes the ventricles to have to dilate to accommodate this increase in volume. The dilation causes the walls of the ventricles to stretch and become thin and weak. Also the myocardium, the muscle layer of the heart, will stretch and not be able to adequately make a full and forceful enough contraction to push blood from the ventricles (Lehne, 2010).

Dyspnea and decreased exercise tolerance- which contributes to diastolic dysfunction with an increase in left ventricular filling pressures with exercises.

In systolic ventricular dysfunction or systolic heart failure the heart is not able to produce enough output for adequate tissue perfusion. Heart rate and stroke volume produce cardiac output. Contractility, preload, and afterload influence the heart’s stroke volume. These factors are important in understanding the pathophysiologic consequences of this syndrome and possible treatments. Patients with systolic heart failure usually have dilated, large ventricles and impaired systolic function.

Patient A.S. is 87-year-old female with a diagnosis of Acute onset chronic systolic heart failure, Afib, CHF, and hypothyroidism. She has a past medical history of Hypertension, diabetes mellitus, CAD (Stent 2001). The patient was admitted to Lutheran Augustana Center on January 4, 2016 and was evaluated for therapy on January 5, 2016. Her current medications include Albuterol and Ipratropium via nebulizer to address shortness of breath. A combination of drugs to treat the symptoms of congestive heart failure and other comorbid diagnosis include: Eliquis, Furosemide, hydralazine, and metoprolol. Other medications include Synthroid to treat hypothyroidism, Tradjenta for hyperglycemia, and Zocor for hyperlipidemia. The patient also presented with skin problems. She has bilateral ecchymosis in her lower extremities and abdomen. Lotrisone lotion was prescribed for atopic dermatitis. Edema was also present in her lower extremities.

Heart disease is the leading cause of death in the United States and the estimated cost of treatment is $32 billion yearly. Approximately 5 million people living in the United States suffer from congestive heart failure (CHF) and half of those diagnosed will die within 5 years. The quality and length of life for someone suffering from heart failure can be improved with early diagnosis, medication, physical activity, and diet modification (CDC, 2013). Congestive heart failure continues to account for more health care cost and readmissions than any other illness. The increase in the prevalence of CHF is contributed to the percentage of elderly population. Adherence to performance measures can increase patient outcomes (Mazimba, Grant, Parikh, Mwandia, Makola, Chilomo, Redko, & Hahn, 2012).

As I read pages 366-367, I understood the pain that Joe was going through. On September 2002 Joe’s wife died of Congestive heart failure. In paragraph 2 on page 366 it reads ‘’He and she were sharing a room at a skilled nursing facility at the time –he recovering from a fractured pelvis and she dying from congestive heart failure and kidney failure. The staff had with uncommon compassion, pushed their beds together so they could hold hands, and that’s how Joyce died .A few days later, Joe went to the memorial service. Then he returned to the room, alone again for the first time in sixty-three years.

Diastolic dysfunction is a problem with the ventricle’s ability to relax and fill. Mixed systolic and diastolic dysfunction is a combination of the two defects (Williams and Hopper).

Congestive heart failure (CHF) is a condition where the heart is unable to efficiently pump blood to supply the body with adequate blood flow and it can cause fluid to build up in the lungs. There are several disease processes and risk factors that predispose an individual to this condition. CHF can be chronic or acute and life threatening, and most of these patients are in the older adult population. Some symptoms of CHF include fatigue, shortness of breath, edema, and diminished exercise capacity. There are several medical management techniques for this condition including lifestyle modifications, medications and surgical intervention. Below, I will summarize two articles on two different medical treatments for CHF.

I. Description: Congestive Heart Failure is more of a syndrome than a disease. Heart failure may be classified according to the side of the heart affected, (left- or right-sided failure), or by the cardiac cycle involved, (systolic or diastolic dysfunction). (Schilling-McCann p. 176). The word "failure" refers to the heart's inability to pump enough blood to meet the body's metabolic needs. (Schilling-McCann p. 176). When the heart fails to deliver adequate blood supply edema may develop. (Cadwallader p. 1141). Where edema occurs depends on what side of the heart is failing.

Intro- Heart Failure is a multifactorial disease due to significant diminishing of heart pumping action. This is occurs in response to many underlying disease such as diabetes, hypertension, myocardial infarction and cardiac myopathies. These conditons lead to hemodynamic instability, neuroendocrine imbalances and structural remodeling of cardiac myocytes. Early less sever hf allows for compensatory mechanisms such as neuroendocrine stimulation- (beta adrenbergic r endothelin norepinephrine r), and hypertrophy which allow for sufficient left ventricular pumping action. However as hf develops these mechanisms become unable to compensate for the progressive underlying disease which results in further loss of contraction and relaxation efficiency and loss of regulation.

Heart failure diagnoses are carried out by a specialized medical practitioner. It comprises of holistic patient health review such as patient medical history, patients symptoms, lungs con-gestion assessment, carrying out physical activity under observation, assessing for fluid re-tention (edema) and also assessing risk factors such as Coronary artery diseases, high blood pressure, Diabetes. According to tansy (2010 1399), heart failure can be diagnosed using different test methods such as Blood tests. This helps to check for any possible diseases in the thyroid, kidney or liver that can cause heart problems (NT-proBNP). N--terminal pro-B-type natriuretic peptide is a chemical checked in the blood. When the heart is under stress BNP is secreted

Diastolic dysfunction is the result of several diseases such as, diabetes mellitus, hypertension, obesity, and chronic kidney disease, which provoke a systemic inflammatory state with high circulating levels of glycoprotein and tumor necrosis factor. This inflammatory state leads to coronary micro vascular endothelial dysfunction with reduced vasodilator response to acetylcholine as a result of low nitric oxide availability and increase in reactive oxygen species production. Diastolic dysfunction will also be the result of an abnormal active process of relaxation linked to an abnormal calcium handling mechanism. This increase in stiffness and decrease in arterial compliance lead to an abnormal vasodilator response to exercise, which causes

Heart failure is a complex clinical disorder of indications and signs that recommend impairment of heart as a pump supporting physiological circulation. It is brought on by basic or useful variations from the norm of the heart. The show of target proof of these cardiovascular variations from the norm is fundamental for the conclusion of heart inability to be made. After a heart attack or a major cardiac surgery, patients normally are dealt with in a clinic's cardiovascular care unit, or CCU, which offers exceptionally particular care until their condition balances out. What might as well be called an intensive care unit, or ICU, which is for basically sick patients with different sorts of conditions, a CCU contains extensive heart monitoring

These findings seen also be shown using fagging. The Tag lines are stretched and fail to break because of restricted motion between the pericardial layers systolic myocardial contraction in usually normal. The following functional abnormalities due to rigid fixed pericardial volume are seen in patients with pericardial constriction: dissociation between intratho-racic and intracardiac pressures, increased filling pressures with equalization of end-di-astolic pressures in all chambers, increased ventricular coupling influenced by respira-tion, elevated systemic venous pressures, and low cardiac output. Although ventricular filling is determined by compliance of cardiac chambers in healthy persons, in patients with pericardial constriction, ventricular filling is limited by pericardial volume; once the constraining volume is reached, there is abrupt cessation of diastolic filling. Ventricular filling can be detected visually on a four-chamber (Fig. S11D [a cine loop]) or short-axis cine image or can be quantified by plotting ventricular volumes against time or by using velocity-encoded phase-contrast MRI in the form of increased early filling and decreased or absent late filling. Diastolic interventricular septal flattening is a finding that has a sensitivity of 62–81% and specificity of 93–100% for constriction [20] in the diagnosis of constriction. In healthy persons, the ventricular septum is not flat: It is convex to the right side because of higher left ventricular pressure, resulting in a positive left-to-right transseptal pressure gradient throughout the cardiac cycle with only minimal respiratory variation. In patients with pericardial constriction, outward expansion of the right ventricle during the early right ventricle filling (which precedes left ventricle filling) is limited by a noncompliant rigid pericardium, resulting in increased right ventricle

Abnormalities in diastolic function mostly manifest as impaired relaxation of the ventricles which can affect the filling of the left ventricle during exercises. This rarely happens during resting period. The dysfunction occurs during the initial stage of left ventricle hypertrophy and can fail to show symptoms for a long period. Progression of disease in a patient with diastolic dysfunction leads to increased filling pressure during normal physical activities and exercises as well. Further progression of the disease causes elevation of filling pressure even at rest, abnormal enlargement of the left atrial and atrial fibrillation as well as reduced exercise tolerance with symptoms of congestive heart failure. During extreme physical activities,