Differences, Treatments, and Prognosis: Systolic Heart Failure vs. Diastolic Heart Failure
In the realm of cardiology, left ventricular heart failure (LVHF) is a common and potentially life-threatening condition. This article aims to shed light on the two main types of LVHF - systolic and diastolic - and the approaches to diagnosis and treatment.
Doctors primarily diagnose both systolic and diastolic LVHF through clinical evaluation and key imaging tests. The transthoracic echocardiogram (TTE) is the preferred initial tool, as it quantitatively measures left ventricular ejection fraction (LVEF), assesses ventricular filling, size, thickness, and detects complications or underlying causes.
Systolic heart failure (HFrEF) is characterised by impaired left ventricular contraction and reduced LVEF. Treatment for HFrEF focuses on reducing afterload and improving cardiac output. This is achieved through a combination of medications such as ACE inhibitors, beta blockers, mineralocorticoid receptor antagonists (MRAs), and Sacubitril/valsartan (ARNI). These drugs help inhibit fluid buildup, slow progression, protect the heart, and manage fluid overload.
On the other hand, diastolic heart failure (HFpEF) is characterised by problems with ventricular relaxation and filling despite normal LVEF. Treatment for HFpEF aims at controlling blood pressure, heart rate, and managing fluid overload. Unfortunately, no therapies have yet demonstrated clear mortality benefit in large trials for HFpEF. However, doctors may use certain medications such as diuretics and beta-blockers to improve symptoms.
Diagnostic imaging is crucial for differentiating types of heart failure and guiding therapy. Chest X-rays assist in assessing cardiomegaly and pulmonary congestion. For complex cases, echocardiography may be used to evaluate parameters like relaxation rate, ventricular stiffness, and filling dynamics during rest and exercise.
In terms of interventions, for HFrEF, device therapy such as Implantable Cardioverter-Defibrillators (ICDs) and pacemakers may be used in selected patients with severe systolic failure. For HFpEF, treatment primarily focuses on managing underlying causes.
Corrective surgery options for left-sided heart failure include heart transplantation, corrective surgery, and cardiac catheterization. Heart transplantation is a procedure of last resort and only takes place when other treatments have failed. Cardiac catheterization surgery involves removing blockages in the coronary arteries.
For people with left-sided heart failure, additional interventions such as Left ventricular assist devices (LVAD), Cardiac resynchronization therapy (CRT), or an Implantable cardioverter-defibrillator (ICD) may be beneficial.
Notably, taking a combination of ACE inhibitors and beta-blockers can reduce a person's risk of death due to heart failure. Furthermore, a study has shown that taking Sacubitril/valsartan can reduce the risk of hospitalization for a person with HFrEF by 64%.
In summary, accurate diagnosis relies on echocardiography to define systolic vs diastolic dysfunction, and treatment uses a combination of medications targeting the specific pathophysiology, with more established evidence and options available for systolic failure. It is essential for individuals with LVHF to work closely with their healthcare providers to manage their condition effectively.
In the context of health-and-wellness and medical-conditions, diagnosing and treating left ventricular heart failure (LVHF) involves various approaches in science, particularly cardiovascular health. Cardiologists utilize diagnostic tools like transthoracic echocardiogram (TTE) to measure left ventricular ejection fraction (LVEF) and assess ventricular filling, size, thickness, and complications. Moreover, the types of LVHF – systolic and diastolic – dictate different treatment approaches, with medications such as ACE inhibitors and beta blockers being common for systolic heart failure (HFrEF), and diuretics and beta-blockers for diastolic heart failure (HFpEF).
