Heart Failure with Preserved Ejection Fraction HFpEF

Question 1

1. Explain the four phase of diastole, with emphasis on when valves open and close and when filling occurs.

Answer 1

the four phase of ventricular diastole: isovolumentric relaxation until aortic valve closure, to mitral valve opening, rapid filling phase, diastasis, and atrial systole.

notice there is normal vacuum that is established after ventricular emptying with the ventricle before it fills again and this vacuums allows suction of blood into the ventricle normally upon relaxation

Question 2

2. Describe how abnormalities of both relaxation and ventricular compliance lead to diastolic dysfunction.

Answer 2

key is abnormal ventricular relaxation or increased diastolic stiffness

Question 3

3. Identify the major chronic illnesses and other conditions prevalent in the US that predispose to diastolic dysfunction.

Answer 3

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Question 4

4. Discuss the role of increased diastolic tension in diastolic dysfunction.

Answer 4

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Question 5

5. Identify common precipitants of clinical diastolic heart failure.

Answer 5

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Question 6

6. Discuss treatment strategies of diastolic heart failure.

Answer 6

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Question 7

7. Describe the changes in aortic pressure contour seen with arterial stiffening and the mechanisms by which this may impair diastolic function.

Answer 7

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Question 8

Give the clinical definition of HFpEF.

Answer 8

a patient with the clinical syndrome of HF, normal left ventricular ejection fraction and no other etiology of the symptoms, AKA diastolic heart failure

filling of the left heart ventricle to a normal end diastolic volume can occur only at higher than normal pressures (to preserve EF, must have higher pressures)

Question 9

Characterize the typical patient with HFpEF.

Answer 9

older obese women with anemia, HTN and CAD, often with aortic stenosis, hypertorphic cardiomyopathy and/or DM