Systolic Heart Failure
Eugene Yevstratov MD
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stratov
Definition
Inability to pump an adequate volume of
blood and/or to do so only from an
abnormally elevated filling pressure,is that
heart failure, can be caused by an
abnormality in systolic function leading to a
defect in the expulsion of blood i.e.
Systolic Heart Failure
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Causes
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Coronary artery disease
Valvular heart disease
Hypertension and aging
Diabetes
Dilated cardiomyopathy
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NYHA classification of heart failure symptoms
• Class 1: No limitations, ordinary physical
activity does not cause undue fatige,
dyspnoea or palpitation (asymptomatic LVD)
• Class 2: Slight limitation of physical activity,
such patients are comfortable at rest
(symptomatically ¨mild¨heart failure)
• Class 3: Marked limitation od physical
activity, less then ordinary physical activity
will lead to symptoms
(symptomatilcally
¨moderade¨heart failure)
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Echo Morphological Classification
• Segmental dysfunction
Focal scarring/dyskinesis most
likely ischemic origin,but
significant regional asymmetry
(even without LBBB) often seen in
DCM
• Global dysfunction
May be due to any of the causes of
systolic dysfunction,
including CAD
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SHF vs Normal Heart Value
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End diastolic volume 135 mVm2 (N80)
End Systolic volume 105 ml/m2 (N40)
Stroke volume 30 ml/m2 (N40)
Ejection fraction 20 % (N50)
End diastolic pressure 25 mmHg (N10)
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Left ventricular systolic
dysfunction is defined as an
ejection fraction of less than
40%
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Clinical Symptoms
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Dyspnoea
Hallmark
Fatigue
symptoms
Periferal oedema
Orthopnoea
Spesific
Paroxysmal nocturnal dyspnoea
symptoms
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Nearly 50% of patients with heart
failure die within five years of the
onest of symptoms
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Identification of SHF
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CAD producing ischemic
cardiomyopathy is the most
common cause of left ventricular
systolic dysfunction
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Physiology
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Preload
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Afterload
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LV remodeling
Pressure overload
Volume overload
normal
Increased DP
Increased SP
Icreased Sσ
Icreased Dσ
+
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Series addition of
new safcomeres
Parallel addition of
new myofibrils
Wall thickening
Chamber enlargement
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Concentric hypertrophy
Eccentric hypertophy
Ventricular Hypertrophy
3
1
5
2
4
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stratov
3
Systolic vs Diastolic Dysfunction
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Treatment of SHF
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Diuretics
Positive Inotropics Drugs
Direct-Acting Vasodilators
Neurohormonal Antagonists
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Treatment of SHF
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Tailored Therapy for Advanced
Heart Failure
•IV nitroprusside and diuretics tailored to
hemodynamics goals
PCW <15mmHg
•Measurment of baseline hemodynamics
SVR< 1200 dynes/s/cm-5
RA < 8mmHg
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SBP > 80 mmHg
•Definition of optional hemodynamics by 23 –
48 hours
•Titration of high-dose oral vasodilators as
nitroprusside weaned
(combination of captopril, ISDN, hydralazine
as needed as alternative or addition)
•Monitored ambulation and diuretic
adjustment for 24 – 48 hours
•Maintain digoxin levels 1.0 – 2.0 ng/dl if no
contraindication
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stratov
Eugene Yevstratov MD
http://www.ctsnet.org/home/eyev
stratov