Diastolic HF- Gupta

Question 1

what is another name for slow filling of diastole?

Answer 1

diastasis

Question 2

describe the flow gradient in diastasis

Answer 2

• no immediate forward driving gradient between LA and LV

Question 3

what physiological state results in absence of diastasis?

Answer 3

• tachycardia

Question 4

is early rapid filling energy dependent or energy independent?

Answer 4

• energy dependent

Question 5

when would you see atrial systole contributing more to filling?

Answer 5

• when pressures are elevated at ventricle, or if you have stiff ventricles

Question 6

what portion of diastolic filling is energy dependent nd which is energy independent?

Answer 6

1. depentent = active myocardical relaxation

2. independent = elastic recoil (depends on the actual chamber geomertry and instrinic myocardial compliance/stiffness)

Question 7

Give 4 barriers to LV filling

Answer 7

1. obstruction to distensibility (constrictive pericarditis/cardiac tamponade)
2. obstruction to filling (intracardiac tumor/valve stenosis)
3. barrier to relaxation (increased heart rate, Post-MI LV scarring/fibrosis/ LV hypertrophy/ restrictive cardiomyopathy)

Question 8

what is diastolic heart failure and how does it differ from diastolic dysfunciton

Answer 8

• diastolic dysfunction (abnormal distensibility ,relaxation, or filling of left ventricle) + isgns and symptoms of heart failure

Question 9

T/F in diastolic dysfunciton you NEED abnormal ejection fraction

Answer 9

• F, you can have normal EF and can be asymptomatic

Question 10

what is upper normal limit for HFpEF?

Answer 10

• greater than or equal to 40 % ejection fraction

Question 11

what patient populations do we see HFpEF in?

Answer 11

• elderly
• females
• hypertension patients
• ischemic heart disease
• diabetes

Question 12

describe the sexual dimorphism for CV risk

Answer 12

• men: higher 45-64 yo

20% higher risk in women after 65

Question 13

describe sexual dimorphism for cardiac structure in terms of:

• LV chamber size and mass
• LV structural stress response

Answer 13

• LV chamber size and mass is initially 15-40 percent lower in women
  
  • men lose myocardium 1 g/yr
  • women protected by effect of estrogen on cell survival
• women do concentric and men do eccentric LV remodeling

Question 14

______ adiposity is most closely associated with increased LV mass

Answer 14

• central adiposity (either due to hyperinsulemia and/or insulin resistance, giving fat infiltration in heart

Question 15

give the difference in active suction between men and women, and what happens with age?

Answer 15

• the elastic recoil and the subsequent suction in enahnced in women ages 20-40; as they age, we see diminished apical rotation

Question 16

T/F you can diagnose diastolic v systolic HF using physical exam

Answer 16

F

Question 17

• give causes of mortality differences between HFREF and HFPEF

Answer 17

• HFREF patients mostly die from CVD complicaiton, while HFPEF patients usually die from other causes

Question 18

describe point, methods, and result of topcat trial

Answer 18

• looking at effective of aldosterone antagonist in managing HF
• no benefit on primary end point for SURVIVAL, but FEWER CHF hospitalization for follow up

Question 19

how does DM contribute to heart failure?

Answer 19

• DM and impaired glucose metaboilsm in general contribute to LVH and arterial stiffness, impairing LV relxation