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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Last updated: May 5, 2010