How is diastolic heart failure best managed?
7Between 30% and 50% of patients with clinical CHF have normal systolic function of the left ventricle. Congestion is generally attributable to abnormal diastolic filling that may be a result of aging, hypertension, ventricular hypertrophy, or ischemic heart disease.25,26 Even during acute pulmonary edema, hypertensive CHF patients manifest intact or even supernormal systolic contractility.27 Diastolic CHF is often associated with concentric left ventricular hypertrophy of hypertensive origin. Pericardial constriction and infiltrative, obstructive hypertrophic, and restrictive cardiomyopathies are observed far less frequently. Ischemic heart disease is often present as well. Aging itself causes reduced myocardial and vascular compliance, with increased myocardial fibrosis and impaired relaxation in diastole. Clinical, ultrasound, nuclear, and hemodynamic methods can verify the diagnostic impression. Some researchers believe that more elderly women than elderly men are likely to have di
