diastolic vs systolic heart failure

[ENThopeful]

could someone explain to me the real difference in findings between systolic and diastolic failure?

as far as i know, diastolic results from mainly hypertrophy, poor filling. systolic results from a dilated ventricle, which leads to poor output.

according to my readings, diastolic can also result in forward failure, while EF is fine, less filling = less going out. it can also result in backward failure, as in pulm edema.

so really, what is the difference between the two? besides what causes it.

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[bluntdissector]

could someone explain to me the real difference in findings between systolic and diastolic failure?

as far as i know, diastolic results from mainly hypertrophy, poor filling. systolic results from a dilated ventricle, which leads to poor output.

according to my readings, diastolic can also result in forward failure, while EF is fine, less filling = less going out. it can also result in backward failure, as in pulm edema.

so really, what is the difference between the two? besides what causes it.

World explains it with the EDV, EDP and ESV. In diastolic (from say hypertrophy) the contractility is okay, but the ventricle space is small. So to keep the EDV and hence the CO sufficient the EDP must increase. ESV would be normal or decreased. It can cause back failure. Systolic failure involves dilated ventricle and less contractility, so Starling kicks in and the EDV is increased, but NOT EDP, in order to keep SV and CO up there. But the ventricly eventually f*cks out and it can cause back failure.

Typed that really quickly, sorry if I didn't explain it well, need to study - 2 or 3 days! 😱

 

[MountainEM]

I agree, this question will most likely be talked about in volumes and pressures:

unfortunetly the notes I took in my FA have slightly different info. WHY? WHY? It always seems like some of these topics have different answers in different places...I gots no time to look anything up right now but here is what I have:

systolic dys (ie dilated cardiomyopathy from say, pregnancy):
decreased EF
increased LVESV, increased LVEDV, and increased LVEDP ( I DONT know why I have increased LVESV here as it seems like the problem is contractility and this should be low as it is the issue?)

diastolic dys (ie hypertrophy or resistrictive cardiomyopathy):
increased/normal EF until way late in the game
LVEDV normal to low
LVEDP increased
not sure about LVESV

???

 

[bluntdissector]

I agree, this question will most likely be talked about in volumes and pressures:

unfortunetly the notes I took in my FA have slightly different info. WHY? WHY? It always seems like some of these topics have different answers in different places...I gots no time to look anything up right now but here is what I have:

systolic dys (ie dilated cardiomyopathy from say, pregnancy):
decreased EF
increased LVESV, increased LVEDV, and increased LVEDP ( I DONT know why I have increased LVESV here as it seems like the problem is contractility and this should be low as it is the issue?)

diastolic dys (ie hypertrophy or resistrictive cardiomyopathy):
increased/normal EF until way late in the game
LVEDV normal to low
LVEDP increased
not sure about LVESV

???

I don't like Merck, but http://www.merck.com/mmhe/sec03/ch025/ch025a.html

Also, World has a nice table on it...but I can't remember which question it was! 😀

 

[bluntdissector]

Most NB diff is that Sys has a reduced EF whilst Dias has a preserved EF. (Harrison's). So I would assume

Sys:
Low EF
High EDV
High ESV
Normal/Increaed EDP

Dias:
Normal EF
Normal EDV
Normal/Low ESV
High EDP

Right?

 

[ENThopeful]

yea those figures look right to me. I guess my question really was on the clinical presentation of the two, but in retrospect, they probably wouldnt make us differentiate something that specific unless it was with what disease they had..

because both essentially cause the same problems

systolic failure = pulm edema, duh and problems with output due to low ef

diastolic failure = pulm edema because you cant fill the heart, and problems with output because while EF is the same, the ventricle chamber is much smaller

someone correct me if im wrong

 

[eduro25]

Hi Ent, the way I see it , according to what I read is :
a) Systolic Failure , anything that impairs cardiac muscle contraction , and hence EF. (and the symtomps asociated with it). Usually they talk about the left ventricle here , and label it as forward failure, which as you correctly expressed EVENTUALLY as blood pools in LV for example , increasing pressure , and then causes Pulm. Edema. (which is of course a backward problem and not a forward one)

b) Diastolic Failure , anything that impairs cardiac filling of the ventricles , and hence you have a direct backward problem. Usually they talk about the RV here , and it translates itself in prominen jugular veins, edema , and so on. If it occurs in LV (hypertrophic myocardiopathy i.e) at first LV might compensate it with Frank Starling , but EVENTUALLY as disease progresses , you will have less EDV (due to impaired filling) , and of course less EF , so it will manifest as a forward problem.

In short words , what you said is correct , just adding my point of view , and that with time one mechanism , derives in another mechanism of HF.

I hope I had been of help.