Hi John
Apologies for the delay
Would like you to tackle the concept of diastolic heart failure in our patient who is a 65 year old female with SLE and an infiltrative cardiomyopathy and presenting with dyspnea She does have CAD but also has an infiltrative disease
So the question is does she have diastolic heart failure to account for her symptoms
Diastolic Heart Failure
aka
Heart failure with preserved ejection fraction (HFpEF).
- Structural Abnormality
- Thick Wall Small cavity
- Enlarged Left Atrium
- Physiology
- Low Cardiac Output
- Elevated End Diastolic Pressures
Many causes
- Most common
- Aging
- Hypertension LVH
- Less Common
- Restrictive Cardiomyopathy
- Commonly caused by infiltrative heart diseases
- We have established in our patient that
- both her ventricles are thick walled
- making infiltrative disease most likely
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Regarding other criteria
-
Is the cavity small? and
-
What does her ejection fraction look like?
- Systole to left and diastole to right
-
Yes the LV cavity is small both by measurement and subjective assessment
-
Re EF (subjective)
-
the end systolic volume is small but is about 1/2 the volume of the end diastolic volume
-
-
Re EF (objective)
-
Calculated EF was 60%
-
-
Re LAE?
-
Both LA and RA look normal
Cardiac Output/Index
Calculated cardiac Index was 2.8 L/min/m2 ( normal range for CI is 2.5 to 4 L/min/m2.)
-
So she has some features of diastolic heart failure
- Small LV cavity
- Thick walled LV
- CI lower limits normal
- But
- LA is normal in size
- Calculated wedge pressure is normal
Next Zohaib Ahmad, Nulling the Myocardium