Why is there heart failure in diastolic dysfunction?

[GonefromTX]

What's the right way to think about diastolic dysfunction? First Aid says Ejection fraction is preserved, and End-diastolic volume is normal. Only compliance is reduced as in hypertrophy. To my understanding, who cares about compliance as long is EF and EDV are normal? Normal EDV and EF means a normal volume of blood will still be pumped out of the left ventricle with each stroke.

So why would heart failure with hypertension ensue?

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[lyana]

we should all care about the compliance because overtime the EDV will drop and EDP will increase--> pulmonary congestion/edema ( if left side involved)

 

[Brorthopedic]

Eventually your left atrium will care about the decreased compliance

 

[sliceofbread136]

Can't fill

 

[GonefromTX]

we should all care about the compliance because overtime the EDV will drop and EDP will increase--> pulmonary congestion/edema ( if left side involved)

High EDP => Pulmonary HTN makes sense. Thanks!

Can't fill

You definitely can fill. Thats what normal EDV means.

 

[sliceofbread136]

High EDP => Pulmonary HTN makes sense. Thanks!

You definitely can fill. Thats what normal EDV means.

It can't fill and you compensate by increasing pressure to force it to fill. Eventually compliance can become so poor that you can no longer compensate and your edv is actually effected. Ef can also be effected if it gets really really bad

 

[CherryRedDracul]

 

[Rekt]

.

 

[Anicetus]

It can't fill and you compensate by increasing pressure to force it to fill. Eventually compliance can become so poor that you can no longer compensate and your edv is actually effected. Ef can also be effected if it gets really really bad

You guys are both sorta right. It can fill but with great difficulty OR it simply can't fill, but it varies between etiologies. Whatever mental image helps you remember it.

Edit: woah I can still post on probationary status? This I did not know...

 

[Levo]

If the left ventricle has diastolic dysfunction, more pressure is needed to fill it properly. That pressure comes from the right ventricle. That higher pressure gets transmitted through the pulmonary arteries, and there can be extravasation of fluid in the process, causing pulmonary edema. Likewise, if the pulmonary hypertension is bad enough and the right ventricle has to work hard enough, the pressures it generates start overcoming the tricuspid valve, and you end up with tricuspid regurgitation. The blood backs up into the rest of the body, causing dependent pitting edema, gut edema, hepatic congestion, etc. I've actually seen someone who was cirrhotic strictly because of bad hepatic congestion from tricuspid regurgitation.

"The most important cause of right heart failure is left heart failure."
-- Every physiology professor ever

 

[takeurmeds02]

Honestly, saying normal EDV is kind of misleading. Maybe initially that'd be true but chronically, when you've actually diagnosed diastolic HF and pt is symptomatic, your EDV should be low; you simply just can't fit enough fluid in that compartment.

Preserved ejection fraction is simply because even while you're filling less, your systole is still working so you pump out a good amount of what you started with; hell your EF can even increase in diastolic dysfunction.