1. Diastolic Dysfunction Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio)

2. Diastole Isovolumetric Relaxation Phase Rapid Filling Phase Diastasis Atrial systoly

3. Diastoly

4. Cardiac cycle Isovolumetric Relaxation Phase Rapid Filling Phase Diastasis Atrial systoly

6. Definition Diastolic Dysfunction refers to abnormalities of active myocardial relaxation and passive ventricular filling. Condition that includes classic CHF findings and abnormal diastolic and normal systolic function at rest

7. Why to know ?? common discharge diagnosis for patients older than 65 years. a patient cannot have pure systolic heart failure 40 percent of patients with heart failure have preserved systolic function. It can be attributed to one of the four underlying mechanisms.

8. Four causes Slow/incomplete myocardial R elaxation: the most common cause of this is myocardial ischaemia, which causes the reduced rate of LV pressure decline Impaired peak LV filling rAte: Pericardial constriction: Altered e lasticity: What is the net effect??

9. The PV curve will be

10. Cellular level EC couple repolarization – relaxation coupling the calcium transient is prolonged as a result of dysfunction of any of the processes mentioned above. Lusitropy

11. Symptoms decreased exercise capacity; Neuro humoral activation with sodium and water retention; paroxysmal nocturnal dyspnoea ; and orthopnoea

12. Diastolic dysfunction

13. Storage diseases Glycogen storage disease Hemochromatosis

14. Common precipitating factors volume overload; tachycardia; exercise; hypertension; ischemia; systemic stressors (e.g., anemia, fever, infection, thyrotoxicosis); arrhythmia increased salt intake; Use of NSAIDs.

15. Diagnosis – ECHO EA Under normal conditions, E is greater than A and the E/A ratio is approximately 1.5. Decrease initial to become one the back to 1.5

16. Transmitral flow velocity

18. Pulmonary venous flow (PVF): During atrial systole, there is normally a small amount of retrograde PVF. In DD, PVF reversal associated with atrial contraction becomes progressively more pronounced

19. Isovolumetric relaxation time IRT normal 70 ms DD it becomes 110 ms Deceleration time (DT): the rate of dissipation of the transmitral pressure gradient is also a function of LV compliance Normal 180 – 240 ms Abnormal > 240 → → 180 ms

20. Diagnosis Tissue Doppler: this uses Doppler shifts of ultrasound waves to calculate the velocity of myocardial tissue movement in a similar way to that of blood flow The serum brain natriuretic peptide (BNP) test can accurately differentiate heart failure from noncardiac conditions in dyspnea, but it cannot distinguish diastolic from systolic heart failure

21. Treatment -Primary prevention smoking cessation aggressive control of hypertension, Hypercholesterolemia, coronary artery disease. Lifestyle modifications such as weight loss, dietary changes, limiting alcohol intake, exercise are equally effective in preventing diastolic and systolic heart failure

22. Treatment Regress left ventricular hypertrophy (decrease wall thickness and remove excess collagen). Beta blockers, ACE inhibitors and ARBs Aldosterone antagonists Calcium channel blockers Maintain atrioventricular synchrony by managing tachycardia Beta blockers (preferred) Calcium channel blockers (second-line agents) Digoxin (controversial)

23. Carvidolol both agents improve cardiac remodeling in patients with congestive heart failure, carvedilol provides superior resolution of left ventricular fraction. Patients who do not respond to metoprolol may improve when switched to carvedilol. carvedilol exhibits more favorable effects on LV function than does nebivolol.

24. Treatment principles Optimize circulating volume (hemodynamics). ACE inhibitors Aldosterone antagonists (theoretical benefit) Salt and water restriction Diuresis, Improve survival. Beta blockers ACE inhibitors

25. SHF and DHF ?? Diuretics ?? Digoxin ?? Venodilators ?? Beta blockers !!

26. summary Phases of diastoly Dysfunction Causes Symptoms Diagnosis Treatment

27. Thank you all