Systolic and Diastolic Dysfunction
First Things First (assess & treat for the following)
- Is there evidence for isolated systolic dysfunction?
- LV ejection fraction < 50%
- Is there evidence for isolated diastolic dysfunction?
- Ejection fraction >50%, but
- Impaired ventricular filling on echocardiography
- Signs of heart failure/cardiogenic shock? (i.e., low/“inadequate” cardiac output)
- Heart failure is a clinical diagnosis (symptoms and signs).
- Treat reversible causes (tamponade, coronary ischemia, pulmonary embolism, thyrotoxicosis, severe anemia, etc.).
- Optimize cardiac output and treat symptoms.
- Inotropic support (drugs, assist devices, etc.)
- Vasodilator therapy and/or afterload reduction
- Diuresis as tolerated
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