Diastolic dysfunction of the pancreas. Classification of diastolic dysfunction of the heart. Normal type of diastolic filling. Is this anomaly dangerous?

The likelihood that people with one or another "heart" diagnosis will reveal signs of diastolic dysfunction of the left ventricle is extremely high, for example, from 50 to 90 percent of patients suffer from such a violation. arterial hypertension.

At first glance, it may seem that failures in the work of a separate part of the myocardium, especially if they do not have pronounced symptoms, do not pose a health hazard. In fact, if left untreated, left ventricular diastolic dysfunction can cause serious fluctuations. blood pressure, provoke arrhythmia and other unpleasant consequences. In this regard, doctors strongly recommend that you carefully consider the state of the main muscle of the body and, with any hint of pathology, contact a specialist. This advice is especially relevant for those who have congenital or acquired heart disease.

Interesting! There is no consensus among medical scientists about whether left ventricular diastolic dysfunction occurs in all hearts, but it is well established that the elderly and those suffering from CHF are most at risk. It is also known that as the condition worsens this pathology is progressing.

Distinctive features of the violation

In the non-specialized literature, left ventricular diastolic disorder is often used as a synonym for diastolic heart failure, although these concepts are not identical. The fact is that in the presence of DHF, a decrease in the elasticity of the left side of the myocardium is always recorded, but often such a problem is only a harbinger of a systolic failure.

Far from always, a person who has a decrease in left ventricular diastolic function is ultimately diagnosed, since this also requires the presence of other characteristic features, as well as a slight decrease in ejection fraction. The decision to make a diagnosis is made by the doctor after a thorough study of the performance of all parts of the myocardium, as well as on the basis of the results of diagnostic procedures.

What causes a decrease in diastolic function?

There can be quite a few reasons why the diastolic function is impaired, and in each person the pathology manifests itself in different ways and can be provoked both by internal disorders and external factors. Among the most common causes:

significant narrowing of the aortic lumen due to fusion of the valve leaflets ();
cardiac ischemia;
regular increase in blood pressure;
overweight;
elderly age.

However, left ventricular diastolic dysfunction also occurs in a number of other cases, for example, in the presence of severe myocardial damage (cardiomyopathy, endocardial disease, etc.), as well as systemic failures caused by amyloidosis, hemochromatosis, hypereosinophilic syndrome, etc. Rarely, however, pathology may develop in effusion constrictive pericarditis and in glycogen storage disease.

Possible symptoms and manifestation of dysfunction

Domestic and external manifestations diastolic dysfunction depends on many factors, in particular, on the state of the heart muscle, or rather, the elasticity of the walls and the success of relaxation of the main muscle of the body.

If the diastolic function of the left ventricle is impaired for one reason or another, then the filling pressure increases to maintain the indicators of the produced blood volume, which is necessary for the normal functioning of the organs. As a result of a failure, as a rule, shortness of breath occurs, which indicates the presence of stagnation in the lungs.

Important! If you do not get rid of excessive pressure to the pulmonary bed, then there is a danger that the dysfunction will subsequently develop into right-sided heart failure.

If the pathology is in a moderate phase, then the symptoms appear periodically, and the heart gradually returns to normal, but in severe cases, rigidity reaches such of great importance that the atria cannot compensate for the required volume. Based clinical picture and the degree of damage, there are such types of diastolic dysfunction of the left ventricle:

Type I - is mainly the result of age-related changes in the structure of the ventricles, manifesting itself in a decrease in the blood pumping fraction and a general decrease in blood volume with a simultaneous increase in systolic volume. The most serious complication is the development of venous stasis, although secondary pulmonary hypertension is also a danger;
Type II (restrictive) - accompanied by a serious increase in rigidity, causing a significant pressure gradient between the chambers at the initial stage of diastole, which is accompanied by a change in the nature of the transmitral blood flow.

An integrated approach is the key to effective therapy

It directly depends on the cause and correctness of diagnosis, how quickly diastolic dysfunction of the left ventricle can be cured. Treatment of this pathology is aimed primarily at neutralizing provoking factors, as well as getting rid of the underlying disease. of cardio-vascular system e.g. ischemic heart disease or hypertension.

Sometimes, in order to restore the myocardium, surgical operation to extract the damaged pericardium, although most often therapy is limited to taking medications, namely:

ACE inhibitors, ARBs;
beta blockers;
diuretics;
calcium channel blockers, etc.

In addition, to maintain the normal state of the “internal engine”, patients with impaired diastolic function are prescribed a diet with a limited amount of sodium, physical management is recommended (especially if there is excess weight), as well as restrictions on the amount of fluid consumed.

In contact with

AT human body everything is arranged with amazing functionality, since in order to maintain the vital activity of the body, all systems and organs must work simultaneously clearly and harmoniously. The functions performed are directly dependent on internal structure organs. The apparent simplicity of their morphological structure is deceptive, because, in fact, every little thing matters here. That is why malformations of organs and any pathologies that have developed as a result of various ailments can be life-threatening. This is especially evident when such pathologies concern the main organ of a person - his heart.

One of the serious pathologies that cause the development of heart disease and subsequently lead to chronic heart failure is diastolic myocardial dysfunction. What is the manifestation of this state?

Features of the heart

First of all, let's trace the relationship between the structure of the heart and the functionality of this organ. Being a kind of fur, consisting of muscle tissue, the heart, contracting, distills the blood supplied to it throughout the body. The further flow of venous blood into the lungs gives it the opportunity to get rid of carbon dioxide and be enriched with oxygen. Arterial blood in the systemic circulation carries oxygen to the cells, provides them with nutrition and release from the residual products of metabolic processes.

However, in order to push the blood in the right direction, the walls of the heart first need to relax in order to receive it. Thus, the process of contraction of the muscle alternates with the process of its relaxation. The period of relaxation of the heart muscle, equivalent in its value for the cardiac cycle with the period of its compression, is called ventricular diastole.

diastolic dysfunction

Relaxation of the heart muscle, combined with lengthening of the muscle fibers, accompanied by a decrease in pressure in the ventricles, leads to the injection of blood into them. The achievement of this result is also facilitated by the compression of the atria. Thus, the loss of the ability of myocardial muscle fibers to relax during the period of diastole, called diastolic dysfunction of the myocardium of the left ventricle, leads to insufficient flow of blood into it. However, in this situation left atrium takes on the task of compensating for the weak activity of the ventricles, since it becomes necessary to contract with an increased load in order to maximize the retraction of blood. This provokes its overload, an increase in volume and an increase in pressure.

This condition often precedes systolic dysfunction, which results in the occurrence of stagnation of blood in the lungs, and then in the veins, which significantly impairs blood flow throughout the body.

Further deterioration of the condition provokes the development of chronic heart failure. A decrease in the blood supply to the heart muscle also leads to ischemia, which is complicated by the degeneration of myocardial fibers into scars consisting of connective tissue, and later to focal necrosis of muscle tissue.

Thus, cardiosclerosis develops with diastolic dysfunction of the myocardium, sometimes accompanied by a violation of compression.

Causes of the disease

It can be argued that the main cause of this disease is the deterioration of the ability of the myocardium to contract and relax, caused by a decrease in the elasticity of muscle tissue. This is provoked by the following diseases:

Also, this condition can be observed in newborns immediately after birth and is called transient myocardial dysfunction. An increase in the blood supply to the lungs and their hyperventilation in infants leads to the following consequences:

Enlargement of the heart chambers.
Atrial overload.
Violation of the contractility of the heart muscle.
Tachycardia.

This condition is not pathological and does not require additional treatment, however, in premature babies and in infants who have undergone hypoxia, it can last longer - about 15 days.

Types of diastolic dysfunction

Diastolic dysfunction of the left ventricle can be of 3 types:

Hypertrophic.
Normal.
Restrictive.

Type 1 diastolic myocardial dysfunction, that is, hypertrophic dysfunction, is the most common type of ailment that occurs asymptomatically in the early stages, and therefore the most insidious. It is based on a decrease in the ability to pump blood from pulmonary artery into the ventricle in the stage of rapid filling due to insufficient elasticity of the myocardium.

Treatment of the disease

Unfortunately, ways to restore myocardial contractility modern medicine not yet found. The treatment of this disease is reduced to the treatment of diseases against which this condition has developed. Therefore, the tasks of doctors are:

Normalization of the heart rate, in order to avoid the development of arrhythmias, for which beta-blockers are taken.
Treatment of ischemia with nitrates.
Stabilization of blood pressure, which is facilitated by the use of diuretics.

Treatment should definitely be carried out under the supervision of a physician.

The heart is our fiery motor, a muscular pump that works throughout life. Unfortunately, there are interruptions in his work, too. Improper lifestyle, burdened heredity, injuries can lead to the development of heart failure. Left ventricular diastolic dysfunction often develops against the background of high blood pressure. Why is this happening?

What are the signs of left ventricular diastolic dysfunction type 1? First of all, these are symptoms caused by fluid retention in the body. A person complains of swelling, especially in the evening. They are most often concentrated in lower extremities. The patient may notice heart pain due to myocardial ischemia, complain of shortness of breath, especially after exercise.

Normally, the heart works in two modes alternately: in systole it contracts, in diastole it relaxes. Dysfunction also means a violation of the normal functioning of any tissue or organ. As a result, the following definition is obtained: diastolic dysfunction of the left ventricle is a violation of the functioning of the left ventricle in the relaxation phase. Why is the left ventricle so important? The fact is that, while contracting, it pushes oxygenated blood into the aorta. From the aorta, through countless vessels, blood is carried to all tissues and organs, saturating them with oxygen. Left ventricle - starting point great circle circulation. If the function of the left ventricle is impaired, the vast majority of the tissues of the human body will suffer from a lack of oxygen.

But after all, the article talks about diastole, and the importance of the left ventricle lies precisely in the fact that it pushes blood into systole, is there a mistake here? Absolutely no contradictions, and here's why: diastole is important because it is during this phase that the heart muscle itself receives much-needed oxygen. It is carried by blood through the coronary or coronary arteries. There are two of them - right and left, they depart from the beginning of the aorta. If the diastole is defective, the left ventricle does not receive oxygen to the proper extent. Metabolism in myocardial cells is disturbed, ischemia occurs. With prolonged ischemia, some of the cells die, and in their place grows connective tissue. This process is called fibrosis (sclerosis). Fibrosed tissue can no longer perform the same function as muscle cells. Naturally, the left ventricle, subjected to such undesirable influences, will not be able to contract fully. We get a violation already in systole, which leads to significant consequences, described a little higher in the text.

In addition to violations of the relaxation phase - the first stage of diastole, the causes of which have already been described above (ischemia, fibrosis), there may be violations of the following two stages - passive filling of the left ventricle with blood (the process is normally provided by the pressure difference between the left atrium and the left ventricle) and active filling ventricular blood (provided by the contraction of the muscle cells of the left atrium; with atrial fibrillation, for example, the left atrium cannot contract to the desired degree, and dysfunction occurs).

What types of left ventricular diastolic dysfunction are distinguished by doctors? There are three of them in total. The first type is hypertrophic. When the heart cannot cope with the load, it tries to compensate for its weakness by increasing the volume and number of muscle cells. The wall of the left ventricle is significantly thickened. At the same time, the relaxation of the left ventricle becomes slower than usual. This type is considered pathological. mild degree gravity and do not be afraid of it. The second type is more serious. To slow down the relaxation of the left ventricle, there is an increase in pressure in the left atrium. Thus, both the first and second stages of diastole are violated. The second type is also called pseudonormal. The third type is restrictive, the most severe. The heart failure is so severe that the patient often needs a heart transplant. If this procedure is not possible, the mortality of patients increases.

Diagnostics of diastolic dysfunction of the left ventricle is carried out by the method of echocardiography, or, as it is called in a simpler and more accessible way, ultrasound of the heart. A well-collected anamnesis also plays a role, from which you can find out the onset of the onset of symptoms, their severity and adjust the treatment taking into account existing diseases.

Ischemia is a constant companion of people who have hypertension. This happens because in this condition, the lumen of the coronary arteries is narrowed more than it should be. Individuals with impaired cholesterol metabolism also suffer, but it is important to remember that Clinical signs begin to appear only when the plaque has already closed 70 percent or more of the lumen of the coronary artery.

Treatment of diastolic dysfunction of the left ventricle according to type 1 is aimed at normalizing the heart rate (normally 60-80 beats per minute), correcting blood pressure (normally 120/80 mm Hg), eliminating the consequences of ischemia. Apart from drug treatment it is important to review the lifestyle, promote the recovery of the diet and the correct psychological attitude of the patient. All this allows you to forget about the disease and live fully.

That is why some violations sometimes occur in the heart.

The most significant in the heart is the left ventricle. A large circle of blood circulation, supplying oxygen to all organs and tissues, except for the lungs, begins precisely in the left ventricle.

Diastolic and systolic functions of the left ventricle

Violation of the systolic function of the left ventricle is a decrease in its ability to pump blood into the aorta and further along its trunk into the systemic circulation. This pathology is the main cause of the development of cardiovascular insufficiency.

Diastolic dysfunction of the left ventricle - a decrease in the ability to take blood into its cavity from the pulmonary circulation through the pulmonary artery system, that is, low diastolic filling.

The disease has several types

Type 1 - violation of relaxation, due to which the amount of blood needed to enter the ventricle decreases. The lack of relaxation leads to atrial hypertrophy due to their increased work;
Type 2 is pseudonormal, relaxation is even worse than type 1. The contribution of the atria is important, which, with the help of high blood pressure in their cavities compensate for the insufficiency of "their brother";
Type 3 - restrictive, more severe stage of the disease, indicates a strong violation of diastolic function, and has an extremely unfavorable prognosis with the subsequent development of chronic heart failure.

This disorder leads to the development of symptomatic arterial hypertension, that is, secondary, and is manifested by the following symptoms:

at the first stages of impaired diastolic function, shortness of breath during heavy and moderate physical exertion, which was not observed before, and subsequently difficulty in breathing even with little work, and sometimes at rest;
dysfunction of the ventricle can be manifested by a dry, hacking cough, which is aggravated at night or during the day while resting in a prone position;
feeling of interruptions in the heart, pain in the chest;
fatigue and decreased performance compared to the previous, "healthy" life.

It is worth remembering that diastolic dysfunction due to the left side of the heart in 45% does not manifest itself in any way.

Causes of impaired diastolic left ventricular function

IHD (cardiac ischemia), which occurs due to insufficient oxygen supply to the myocardium and causes the death of cardiomyocytes. As you know, the role of blood in the body is very large, it is a carrier of the necessary elements: hormones, oxygen, microelements.
Sclerosis of the heart, which appeared as a result of a heart attack (postinfarction cardiosclerosis). Sclerosis is not a violation of memory, as people think. This is the hardening of tissues. If scars appear on the organ, this interferes not only with normal metabolism, but also disrupts the function of stretching. Even the myocardium is not protected from such a disease. Depending on the localization of the disease that led to cardiosclerosis, different disorders are distinguished. And one of them is a disorder of the diastolic function of the left ventricle.
Hypertrophic cardiomyopathy - thickening of the left side of the heart also leads to abnormal diastolic function.
Primary arterial hypertension.
Stenosis or insufficiency of the aortic valve.
Inflammation of the pericardium (outer membrane from the heart) with the imposition of fibrin threads - fibrinous pericarditis. Fibrin tightens the heart muscle and prevents it from working fully.

Treatment

Therapy depends on the stage and severity of the disease, it is categorically contraindicated to prescribe this or that drug to yourself, because the heart is a vital organ, so it is better not to harm your health with wrong actions.

If there are no symptoms of deficiency, the doctor may advise taking an angiotensin-converting enzyme (ACE) inhibitor. It is a regulator of blood pressure and protects the target organs in this disease.

Target organs are those that suffer primarily in the dysfunction of the cardiovascular system, that is, they are the first "targets" in the path of blood failure. These include the kidneys, brain and spinal cord, heart, blood vessels and retina.

Taking ACE inhibitors daily at the dose prescribed by your doctor can reduce the risk of developing complications in target organs and prevent the development of chronic heart failure. These drugs include Enalapril, Quadropril, Lisinopril. It is difficult to say which is better, everything is discussed at the appointment with a therapist or cardiologist and is prescribed based on the symptoms and past experience with medications.

If you have intolerance to ACE inhibitors, or for some objective reason, the doctor decided that they will not help you, ARA II (angiotensin receptor antagonists) are prescribed. They have exactly the same properties. These include Losartan, Valsartan and others.

With pronounced signs of the disease, even more drugs are prescribed to relieve symptoms:

diuretics (diuretics) - reduce the volume of circulating blood due to the withdrawal of excess fluid;
beta-blockers - make the heart rate less frequent, reducing the load on the organ;
cardiac glycosides - increase the force of contractions of the heart;
Aspirin - prescribed to reduce the risk of blood clots and, therefore, ischemia;
statins - exercise lipid control in the blood by normalizing cholesterol fractions that are harmful to blood vessels.

Forecast

Given the severity of the disease, it cannot be launched. Remember that postponing a trip to the doctor, you only harm your health. There are so many in the world medicines that for you there is one that will reduce unpleasant symptoms. By following a healthy lifestyle, eating right, and following the recommendations of your healthcare provider, you can greatly reduce your risk of complications and worsening of the condition.

Diastolic dysfunction of the left ventricle, type 1

Left ventricular diastolic dysfunction type 1 is a heart disease characterized by an insufficient ability of the left ventricle to relax during diastole - general relaxation. As a rule, this period takes about 0.4 seconds, and it is enough to fully restore the tone and energy content of the heart muscle.

Etiology and pathogenesis

Factors predisposing to the development of LVDD are:

Hypertension, especially malignant, with sharp and high rises in blood pressure.
Hypertrophic cardiomyopathy caused by a pathological increase in the load on the left ventricle.

The pathogenesis of the disease is directly related to a decrease in the filling of the heart with blood, a decrease in cardiac output, and pulmonary hypertension. Insufficient throughput The left ventricle, which supplies blood to the systemic circulation, leads to tissue ischemia. In addition, increased diastolic pressure develops in the heart and, as a result, an increase in pressure in the pulmonary vein system. The latter, in severe cases, leads to the development pulmonary edema. In addition, peripheral vascular resistance increases, which leads to the development of edema and excessive excretion of potassium salts from the body.

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Symptoms

The disease can be asymptomatic for a long time. Subsequently, patients begin to notice such signs as swelling of the lower extremities, pain in the heart, which are paroxysmal in nature. coronary disease, shortness of breath, often even at rest, a feeling of lack of air, spastic phenomena.

Treatment

Treatment of dysfunction consists in prescribing drugs of the ACE blocker group to the patient. In this case, the drug of choice is often lisonopril. Assign it in tablet form pomg / day, divided into two doses.

Good results in the treatment of such a disease as type 1 left ventricular diastolic dysfunction can also be achieved through the use of calcium blockers. Both drug groups help to reduce blood pressure, reduce the need for oxygen in the heart tissues, stop or reduce LV hypertrophy. In addition, as a result of their intake, the function of the diastole of the heart improves, which leads to the normalization of hemodynamics. The best results of treatment were observed with a combination of cardiological medicines with potassium-sparing diuretics. If necessary, other antihypertensive drugs can be used.

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Overview of Left Ventricular Diastolic Dysfunction: Symptoms and Treatment

In this article, you will learn: everything important about left ventricular diastolic dysfunction. The reasons for which people have such a violation of the heart, what symptoms this disease gives. Necessary treatment, how long it should be carried out, whether it is possible to recover completely.

Left ventricular diastolic dysfunction (abbreviated as LVDD) is insufficient filling of the ventricle with blood during diastole, that is, the period of relaxation of the heart muscle.

This pathology is more often diagnosed in women of retirement age suffering from arterial hypertension, chronic heart failure (CHF for short) or other heart diseases. In men, left ventricular dysfunction is much less common.

With such a dysfunction, the heart muscle is unable to fully relax. From this, the filling of the ventricle with blood decreases. This dysfunction of the left ventricle affects the entire period of the cycle heart contraction: if during diastole the ventricle was not sufficiently filled with blood, then during systole (myocardial contraction) little of it will be pushed into the aorta. This affects the functioning of the right ventricle, leads to the formation of blood stasis, in the future to the development of systolic disorders, atrial overload, CHF.

This pathology is treated by a cardiologist. It is possible to involve other narrow specialists in the treatment process: a rheumatologist, a neurologist, a rehabilitation specialist.

It will not be possible to completely get rid of such a violation, since it is often provoked by an underlying disease of the heart or blood vessels or their age-related wear. The prognosis depends on the type of dysfunction, the presence of concomitant diseases, the correctness and timeliness of treatment.

Types of left ventricular diastolic dysfunction

Reasons for development

More often, the reasons are a combination of several factors:

elderly age;
arterial hypertension;
overweight;
chronic heart pathologies: arrhythmias or other rhythm disturbances, myocardial fibrosis (replacement of muscle tissue with fibrous tissue, which is unable to contract and conduct electrical impulses), aortic stenosis;
acute cardiac disorders, such as a heart attack.

Violation of blood flow (hemodynamics) can cause:

pathologies of the circulatory system and coronary vessels: thrombophlebitis, ischemia of the heart vessels;
constrictive pericarditis with thickening of the outer shell of the heart and compression of the heart chambers;
primary amyloidosis, in which the elasticity of the myocardium decreases due to the deposition of special substances that cause atrophy of muscle fibers;
postinfarction cardiosclerosis.

Symptoms

LVDD is asymptomatic in about 45% of cases long time, especially in hypertrophic and pseudonormal types of pathology. Over time, and in the most severe, restrictive type, the following manifestations are characteristic:

Dyspnea. Appears at first only with intense physical activity, later at rest.
Weakness, fatigue, decreased exercise tolerance.
Irregular heart rhythm, more often its acceleration or atrial fibrillation.
Shortness of breath, pressure in the chest.
Cardiac cough worse lying down.
Swelling of the ankles.

On the initial stages diastolic dysfunction, the patient is unaware of the onset of a violation of the heart, and writes off weakness and shortness of breath for banal fatigue. The duration of this asymptomatic period varies from person to person. A visit to a doctor occurs only when there are tangible clinical signs, for example, shortness of breath at rest, swelling of the legs, affecting the quality of life of a person.

Basic diagnostic methods

Among the additional measures, it is possible to study the function thyroid gland(determination of the level of hormones), X-ray chest, coronary angiography, etc.

Treatment

It is possible to cope with a violation of the left ventricular diastolic function only if it is caused by a cardiac surgical pathology that can be completely eliminated surgically. In other cases, problems with heart diastole are corrected with medication.

Therapy is primarily aimed at correcting circulatory disorders. The quality of his future life depends on the timeliness, correctness of treatment and the strict implementation of medical recommendations by the patient.

The goals of medical measures:

elimination of heart rhythm disturbances (normalization of the pulse);
stabilization of blood pressure;
correction of water-salt metabolism;
elimination of left ventricular hypertrophy.

Forecast

Violation of the diastolic function of the left ventricle cannot be completely stopped, but with adequate medical correction of circulatory disorders, treatment of the underlying disease, proper nutrition, mode of work and rest, patients with such a violation live a full life for many years.

Despite this, it is worth knowing what a violation of the cardiac cycle is - dangerous pathology, which cannot be ignored. With a bad course, it can lead to a heart attack, stagnation of blood in the heart and lungs, and swelling of the latter. Complications are possible, especially with a severe degree of dysfunction: these are thrombosis, pulmonary embolism, ventricular fibrillation.

In the absence of proper treatment, severe dysfunction with severe CHF, the prognosis for recovery is unfavorable. In most of these cases, everything ends with the death of the patient.

With regular proper treatment, adjusting nutrition with salt restriction, controlling the condition and level of blood pressure and cholesterol, the patient can count on a favorable outcome, prolonging life, and active.

Diastolic dysfunction of the left ventricle. Diagnosis and treatment approaches

Heart diseases are increasingly common in medical practice. They must be carefully studied and examined in order to be able to prevent negative consequences. Left ventricular diastolic dysfunction is a common disorder that can cause heart failure accompanied by pulmonary edema or cardiac asthma.

Scheme of the development of pathology

Dysfunction of the ventricle is more often an age-related disorder and occurs mainly in the elderly. Women are especially susceptible to this pathology. Diastolic dysfunction of the left ventricle causes hemodynamic disturbances and atrophic changes in the structure of the myocardium. The period of diastole is characterized by muscle relaxation and filling of the ventricle with arterial blood. The process of filling the heart chamber consists of several stages:

relaxation of the heart muscle;
under the influence of the pressure difference from the atrium, the blood passively flows into the ventricle;
when the atria contract, the remaining blood is pushed sharply into the ventricle.

If one of the stages is violated, insufficient blood ejection is observed, which contributes to the development of left ventricular failure.

Reasons for the development of the disease

Dysfunction of the ventricle of the diastolic type can be caused by certain diseases that can significantly disrupt the hemodynamics of the heart:

Left ventricular diastolic dysfunction is a consequence of thickening of the heart muscle tissue (myocardial hypertrophy). As a rule, hypertrophy develops in people with hypertension, aortic stenosis and hypertrophic cardiomyopathy.
It can develop under the influence of pericarditis, as a result of which the thickened walls of the pericardium compress the chambers of the heart.
At pathological changes coronary vessels, which cause coronary heart disease due to coarsening of the heart tissue and the appearance of scars.
Amyloidosis causes a decrease in muscle elasticity and atrophic changes in the fibers of the heart.

Especially often the disease develops in people with diabetes or obesity. In this case, the pressure on the chambers of the heart increases, the organ cannot fully function, and ventricular dysfunction develops.

Signs of the disease

Diastolic dysfunction of the left ventricle for a long time can practically not disturb the patient. However, this pathology is accompanied by certain symptoms:

cardiopalmus;
cough, more often in a horizontal position;
increased fatigue with habitual physical exertion;
shortness of breath at first accompanies only during physical exertion, then sharply occurs even at rest;
heart rhythm disturbances, manifested by atrial fibrillation;
at night, difficulty breathing (dyspnea) may disturb.

If you experience these symptoms, you should contact medical care and undergo an examination to identify the cause of discomfort and eliminate the disease at an early stage.

Varieties of diastolic dysfunction

Since the disease gradually worsens the hemodynamics of the heart, there are several stages:

Stage 1 is characterized by minor hemodynamic disturbances. Type 1 left ventricular diastolic dysfunction causes a slow transition of the chambers from systole to diastole, the main volume of blood enters the ventricle during the relaxation of its chambers.
Stage 2 - the filling of the ventricle is carried out due to the pressure difference, since at this stage the pressure rises reflexively in the left atrium.
Stage 3 - The pressure in the left atrium remains high, while the left ventricle becomes rigid, losing the elasticity of the fibers.

Left ventricular diastolic dysfunction type 1 is treatable, while subsequent stages of the disease cause irreversible changes in the functioning and physiological state of the organ. That is why it is necessary to consult a doctor at the first manifestation of symptoms of the disease.

Diagnostic examinations

To identify physiological changes and violations of the hemodynamics of the heart, it is necessary to conduct a full examination, which includes several diagnostics:

Echocardiography with complementary Doppler is the most accessible and informative method examinations of the cardiovascular system. With it, you can quickly identify whether a person has heart failure. Treatment should be carried out on the basis of a complete picture of the examinations carried out.
Electrocardiography examines the state of the myocardium, in particular the presence of hypertrophic changes, determines the presence of cardiac ischemia. It is an auxiliary research method.
Ventriculography shows disturbances in the heart rhythm, is prescribed for unsatisfactory echocardiography.
If necessary, an x-ray examination is prescribed to detect pulmonary hypertension.

Using the above methods, the types of diastolic dysfunction of the left ventricle are also determined.

Treatment of the disease

To eliminate violations of the hemodynamic process and prevent the development of irreversible changes, it is necessary to prescribe drugs that allow maintaining optimal indicators of the work of the heart (blood pressure, heart rate). Normalization of water-salt metabolism will reduce the load on the heart. Elimination of left ventricular hypertrophy is also required.

After the examination, the attending physician will select a suitable set of drugs that can maintain all indicators in the normal range. Heart failure also plays an important role, the treatment of which requires compliance with a large number medical recommendations.

Prevention of heart disease

To avoid the development of most heart pathologies, it is necessary to adhere to healthy lifestyle life. This concept includes regular healthy eating sufficient physical activity, lack of bad habits and regular body check-ups.

Diastolic dysfunction of the left ventricle, the treatment of which requires high professionalism of the doctor and strict adherence to all his appointments, is rare in young active people. That is why with age it is important to maintain activity and periodically take vitamin complexes helping to saturate the body with essential trace elements.

Diastolic dysfunction of the myocardium of the left ventricle, which is detected in time, will not bring much harm to human health and will not cause serious atrophic changes in the heart tissue.

Types of violations of diastolic function of the left ventricle

Diastolic dysfunction of the left ventricle is a failure in the process of filling it with blood during diastole (relaxation of the heart muscle), i.e. the ability to pump blood from the pulmonary artery system into the cavity of this chamber of the heart decreases, and, consequently, its filling decreases during relaxation. Diastolic disorder of the left ventricle is manifested by an increase in the ratio of such indicators as its final pressure and final volume during diastole.

Interesting! This disease is usually diagnosed in people over 60, most often in women.

The diastolic function of the left ventricle (its filling) includes three stages:

relaxation of the heart muscle, which is based on the active removal of calcium ions from the filaments of muscle fibers, relaxing the contracted myocardial muscle cells and increasing their length;
passive filling. This process directly depends on the compliance of the walls of the latter;
filling, which is carried out due to the reduction of the atria.

Various factors entail a decrease in the diastolic function of the left ventricle, which manifests itself in a violation of one of its three stages. As a result of this pathology, the myocardium does not have enough blood volume to provide normal cardiac output. This leads to the development of left ventricular failure and pulmonary hypertension.

Interesting! It has been proven that this pathological process precedes changes in systolic function, and can also lead to the development of chronic heart failure in cases where stroke volume and minute volume of blood, cardiac index and ejection fraction have not yet been changed.

What caused this violation?

Violation of the diastolic function of the left ventricle, accompanied by a deterioration in the relaxation processes and a decrease in the elasticity of its walls, is most often associated with myocardial hypertrophy, i.e. thickening of its walls.

The main causes of cardiac muscle hypertrophy are:

cardiomyopathy of various origins;
hypertension;
narrowing of the aortic mouth.

Factors contributing to the development of hemodynamics in diastolic dysfunction in this section of the myocardium are:

thickening of the pericardium, which leads to compression of the chambers of the heart;
infiltrative damage to the myocardium, as a result of amyloidosis, sarcoidosis and other diseases leading to atrophy of muscle fibers and a decrease in their elasticity;
pathological processes of the coronary vessels, especially ischemic disease, which leads to an increase in myocardial stiffness due to scarring.

Important! The risk group for the development of pathology includes people who are obese and those with diabetes mellitus.

How does the disease manifest itself?

Functional disorder of left ventricular diastole can be asymptomatic for a long time before the first clinical symptoms. The following clinical signs of diastolic dysfunction of the left ventricle are distinguished:

failure of the heart rhythm (atrial fibrillation);
severe dyspnea, which manifests itself a couple of hours after falling asleep;
cough that worsens when lying down;
shortness of breath, which at first manifests itself only during physical exertion, and with the progression of the disease - and at rest;
fast fatiguability.

Types of pathology and their severity

Today, the following types of diastolic dysfunction of the left ventricle are distinguished:

I-th, which is accompanied by a violation of the process of relaxation (its slowdown) of this chamber of the heart in diastole. The required amount of blood at this stage comes with atrial contractions;
II-th, characterized by an increase in pressure in the left atrium, due to which the filling of the adjacent lower chamber of the heart is possible only due to the action of a pressure gradient. This is the so-called. pseudonormal type.
III, associated with an increase in pressure in the atrium, a decrease in elasticity and an increase in the rigidity of the walls of the ventricle (restrictive type).

Functional disturbance of diastole in this chamber of the heart is formed gradually, and is divided into 4 degrees of severity: mild (I type of disease), moderate (II type of disease), severe reversible and irreversible (III type of disease).

How can the disease be diagnosed?

If the diastolic function of the left ventricle is impaired and the disorder is detected in the early stages, then the development of irreversible changes can be prevented. Diagnosis of this pathology is carried out by such methods:

two-dimensional echocardiography in combination with Doppler sonography, allowing to obtain a real-time image of the myocardium and evaluate its hemodynamic functions.
ventriculography using radioactive albumin to determine the contractile function of the heart in general and the required chamber in particular;
ECG, as an auxiliary study;
chest x-ray, to determine the first symptoms of pulmonary hypertension.

How is a functional disorder treated?

As already noted, diastolic dysfunction of the left ventricle, the treatment of which depends on the type of disease, primarily affects the processes of hemodynamics. Therefore, the therapy plan is based on the correction of violations of this process. In particular, regular monitoring of blood pressure, heart rate and water-salt metabolism is carried out, followed by their correction, as well as remodeling of myocardial geometry (reduction of thickening and return of the walls of its chambers to normal).

Among the drugs used to treat functional impairment diastole this department hearts are divided into the following groups:

blockers;
drugs to improve the elasticity of the heart muscle, reduce pressure, reduce preload and promote myocardial remodeling (sartans and inhibitors and ACE);
diuretics (diuretics);
drugs that reduce the level of calcium in the cells of the heart.

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Myocardial dysfunction of the ventricles of the heart: causes, symptoms, treatment

In order for every cell of the human body to receive blood with vital oxygen, the heart must work correctly. The pumping function of the heart is carried out with the help of alternate relaxation and contraction of the heart muscle - myocardium. If any of these processes are disturbed, dysfunction of the ventricles of the heart develops, and the ability of the heart to push blood into the aorta gradually decreases, which affects the blood supply to the vital important organs. Dysfunction or myocardial dysfunction develops.

Ventricular dysfunction of the heart is a violation of the ability of the heart muscle to contract during the systolic type to expel blood into the vessels, and relax during the diastolic type to take blood from the atria. In any case, these processes cause disruption of normal intracardiac hemodynamics (blood flow through the heart chambers) and blood stasis in the lungs and other organs.

Both types of dysfunction are associated with chronic heart failure - the more impaired ventricular function, the greater the severity of heart failure. If CHF can be without heart dysfunction, then dysfunction, on the contrary, does not occur without CHF, that is, every patient with ventricular dysfunction has chronic heart failure of the initial or severe stage, depending on the symptoms. This is important to consider for the patient if he believes that taking medication is not necessary. You also need to understand that if a patient is diagnosed with myocardial dysfunction, this is the first signal that some processes are taking place in the heart that need to be identified and treated.

Left ventricular dysfunction

diastolic dysfunction

Diastolic dysfunction of the left ventricle of the heart is characterized by a violation of the ability of the myocardium of the left ventricle to relax for full filling with blood. The ejection fraction is normal or slightly higher (50% or more). AT pure form diastolic dysfunction occurs in less than 20% of all cases. There are the following types of diastolic dysfunction - violation of relaxation, pseudo-normal and restrictive type. The first two may not be accompanied by symptoms, while the last type corresponds to severe CHF with severe symptoms.

The reasons

Cardiac ischemia,
Postinfarction cardiosclerosis with myocardial remodeling,
Hypertrophic cardiomyopathy - an increase in the mass of the ventricles due to thickening of their walls,
arterial hypertension,
aortic valve stenosis,
Fibrinous pericarditis - inflammation of the outer shell of the heart, the heart "bag",
Restrictive myocardial lesions (endomyocardial Loeffler's disease and endomyocardial fibrosis Davis) - thickening of the normal structure of the muscular and inner lining of the heart, which can limit the process of relaxation, or diastole.

signs

Asymptomatic course is observed in 45% of cases of diastolic dysfunction.

Clinical manifestations are due to an increase in pressure in the left atrium due to the fact that blood cannot enter the left ventricle in sufficient volume due to its constant stay in a tense state. Blood stagnates in the pulmonary arteries, which is manifested by such symptoms:

Shortness of breath, at first slight when walking or climbing stairs, then pronounced at rest,
Dry hacking cough, aggravated by lying down and at night,
Feelings of interruptions in the work of the heart, chest pain, accompanying cardiac arrhythmias, most often, atrial fibrillation,
Fatigue and inability to perform previously well-tolerated physical activities.

Systolic dysfunction

Systolic dysfunction of the left ventricle is characterized by a decrease in the contractility of the heart muscle and a reduced volume of blood ejected into the aorta. Approximately 45% of persons with CHF have this type of dysfunction (in other cases, the function of myocardial contractility is not impaired). The main criterion is a decrease in the left ventricular ejection fraction according to the results of an ultrasound of the heart of less than 45%.

The reasons

Acute myocardial infarction (in 78% of patients with a heart attack, left ventricular dysfunction develops on the first day),
Dilated cardiomyopathy - expansion of the cavities of the heart due to inflammatory, dyshormonal or metabolic disorders in the body,
Myocarditis of a viral or bacterial nature,
Mitral valve insufficiency (acquired heart disease),
hypertension on late stages.

Symptoms

The patient can mark as having characteristic symptoms and their complete absence. In the latter case, they speak of asymptomatic dysfunction.

Symptoms of systolic dysfunction are due to a decrease in the ejection of blood into the aorta, and, consequently, the depletion of blood flow in the internal organs and skeletal muscles. The most characteristic signs:

Paleness, bluish discoloration and coldness skin, swelling of the lower extremities,
Rapid fatigue, causeless muscle weakness,
Changes in the psycho-emotional sphere due to depletion of the blood flow of the brain - insomnia, irritability, memory impairment, etc.,
Impaired kidney function, and the resulting changes in blood and urine tests, increased blood pressure due to activation of the renal mechanisms of hypertension, swelling on the face.

Right ventricular dysfunction

The reasons

As the causes of right ventricular dysfunction, the above diseases remain relevant. In addition to them, isolated right ventricular failure can be caused by diseases of the bronchopulmonary system (severe bronchial asthma, emphysema, etc.) birth defects heart and malformations of the tricuspid valve and pulmonic valve.

Symptoms

The dysfunction of the right ventricle is characterized by symptoms that accompany stagnation of blood in the organs of the systemic circulation (liver, skin and muscles, kidneys, brain):

Pronounced cyanosis (blue coloration) of the skin of the nose, lips, nail phalanges, tips of the ears, and in severe cases of the entire face, arms and legs,
Edema of the lower extremities, appearing in the evening and disappearing in the morning, in severe cases - swelling of the whole body (anasarca),
Violations of the liver, up to cardiac cirrhosis in the later stages, and the resulting increase in the liver, pain in the right hypochondrium, an increase in the abdomen, yellowness of the skin and sclera, changes in blood tests.

Diastolic dysfunction of both ventricles of the heart plays a decisive role in the development of chronic heart failure, and systole and diastole disorders are links in the same process.

What examination is needed?

If the patient has found symptoms similar to signs of ventricular myocardial dysfunction, he should consult a cardiologist or general practitioner. The doctor will examine you and prescribe any of the additional methods examinations:

Routine methods - blood and urine tests, biochemical blood tests to assess hemoglobin levels, performance indicators internal organs(liver, kidney)
Determination in the blood of potassium, sodium, sodium - uretic peptide,
A blood test for hormone levels (determination of the level of thyroid hormones, adrenal glands) with a suspicion of an excess of hormones in the body that have a toxic effect on the heart,
ECG is a mandatory research method that allows you to determine whether there is myocardial hypertrophy, signs arterial hypertension and myocardial ischemia
ECG modifications - treadmill test, bicycle ergometry - this is an ECG recording after exercise, which allows you to assess changes in myocardial blood supply due to exercise, as well as assess exercise tolerance in case of shortness of breath in CHF,
Echocardiography is the second mandatory instrumental research, the "gold standard" in the diagnosis of ventricular dysfunction, allows you to evaluate the ejection fraction (normally more than 50%), assess the size of the ventricles, visualize heart defects, hypertrophic or dilated cardiomyopathy. To diagnose dysfunction of the right ventricle, its final diastolic volume is measured (normally 15-20 mm, with dysfunction of the right ventricle it increases significantly),
Radiography chest cavity- an auxiliary method for myocardial hypertrophy, which allows you to determine the degree of expansion of the heart in diameter, if there is hypertrophy, to see the depletion (with systolic dysfunction) or strengthening (with diastolic) of the pulmonary pattern due to its vascular component,
Coronary angiography - the introduction of a radiopaque substance into the coronary arteries to assess their patency, the violation of which accompanies coronary heart disease and myocardial infarction,
MRI of the heart is not a routine method of examination, however, due to the greater information content than ultrasound of the heart, it is sometimes prescribed in diagnostically controversial cases.

When to start treatment?

Both the patient and the doctor must be clearly aware that even asymptomatic ventricular myocardial dysfunction requires an appointment medications. Simple rules for taking at least one tablet a day can prevent the onset of symptoms for a long time and prolong life in the event of severe chronic insufficiency circulation. Of course, at the stage of severe symptoms, one tablet does not improve the patient's well-being, but the most appropriately selected combination of drugs can significantly slow down the progression of the process and improve the quality of life.

So, at an early, asymptomatic stage of the course of dysfunction, ACE inhibitors or, if they are intolerant, angiotensin II receptor antagonists (ARA II) must be prescribed. These drugs have organoprotective properties, that is, they protect the organs most vulnerable to the adverse effects of persistently high blood pressure, for example. These organs include the kidneys, brain, heart, blood vessels and retina. Daily intake of the drug at a dose prescribed by a doctor significantly reduces the risk of complications in these structures. In addition, ACE inhibitors prevent further myocardial remodeling, slowing down the development of CHF. Among the drugs prescribed are enalapril, perindopril, lisinopril, quadripril, from ARA II losartan, valsartan and many others. In addition to them, the treatment of the underlying disease that caused the dysfunction of the ventricles is prescribed.

At the stage of severe symptoms, for example, with frequent shortness of breath, nocturnal asthma attacks, swelling of the limbs, all major groups of drugs are prescribed. These include:

Diuretics (diuretics) - veroshpiron, diuver, hydrochlorothiazide, indapamide, lasix, furosemide, torasemide eliminate blood stasis in organs and lungs,
Beta-blockers (metoprolol, bisoprolol, etc.) slow down the frequency of heart contractions, relax peripheral vessels, helping to reduce the load on the heart,
Calcium channel inhibitors (amlodipine, verapamil) - act similarly to beta-blockers,
Cardiac glycosides (digoxin, corglycone) - increase the strength of heart contractions,
Combinations of drugs (noliprel - perindopril and indapamide, amozartan - amlodipine and losartan, lorista - losartan and hydrochlorothiazide, etc.),
Nitroglycerin under the tongue and in tablets (monocinque, pectrol) for angina pectoris,
Aspirin (thromboAss, aspirin cardio) to prevent thrombus formation in the vessels,
Statins - to normalize blood cholesterol levels in atherosclerosis and coronary heart disease.

What lifestyle should be observed in a patient with ventricular dysfunction?

First of all, you need to follow a diet. You should limit the intake of table salt with food (no more than 1 gram per day) and control the amount of fluid you drink (no more than 1.5 liters per day) to reduce the load on circulatory system. Nutrition should be rational, according to the regimen of eating with a frequency of 4-6 times a day. Fatty, fried, spicy and salty foods are excluded. It is necessary to expand the consumption of vegetables, fruits, sour-milk, cereals and grain products.

Second paragraph non-drug treatment It's a lifestyle change. It is necessary to abandon all bad habits, observe the regime of work and rest and devote sufficient time to sleep at night.

The third point is sufficient physical activity. Physical exercise should correspond to the general capabilities of the organism. It is quite enough to take walks in the evening or sometimes get out for mushrooms or go fishing. In addition to positive emotions, this type of rest contributes to the good work of neurohumoral structures that regulate the activity of the heart. Of course, during the period of decompensation, or worsening of the course of the disease, all loads should be excluded for a time determined by the doctor.

What is the danger of pathology?

If a patient with an established diagnosis neglects the doctor's recommendations and does not consider it necessary to take the prescribed drugs, this contributes to the progression of myocardial dysfunction and the appearance of symptoms of chronic heart failure. For everyone, such progression proceeds differently - for someone slowly, over decades. And someone quickly, during the first year from the diagnosis. This is the danger of dysfunction - in the development of severe CHF.

In addition, complications may develop, especially in the case of severe dysfunction with an ejection fraction of less than 30%. These include acute heart failure, including left ventricular (pulmonary edema), pulmonary embolism, fatal arrhythmias (ventricular fibrillation), etc.

Forecast

In the absence of treatment, as well as in the case of significant dysfunction accompanied by severe CHF, the prognosis is unfavorable, since the progression of the process without treatment invariably ends in death.

In modern terminology - systolic heart failure. However, in the late 1970s - 80s it became clear that a significant proportion of patients with a clinical picture of heart failure have normal contractile function of the heart, normal values of the left ventricular ejection fraction. Such a clinical picture in modern terminology is described as diastolic heart failure.

The study of diastole and, in fact, diseases associated with its changes, began as early as 1877, when Francois-Franck, on the basis of experiments, concluded that the maximum filling of the left ventricle with blood occurs in early diastole. In 1906, Hendorson described the three phases of diastole, and in 1921, Wiggers and Katz found that the contribution of the left atrium to left ventricular filling can be increased in people with altered LV properties. In 1927, Meek experimentally established that the phase of active myocardial relaxation in diastole affects myocardial contractility. In 1949, Wiggers introduced the term "intrinsic elasticity" to describe the behavior of the LV myocardium during diastole, i.e. made an attempt to describe the main state of the myocardium in diastole - relaxation.

In 1975 W.H. Gaasch in a series of experimental and clinical studies identified differences in diastole in healthy people and patients with cardiovascular diseases, using a change in pressure in the LV cavity and a change in its volume. In particular, it was found that the volume of blood during passive filling of the left ventricle is reduced in patients with cardiovascular diseases. In 1983-1984 N.N. Echeverria, A.N. Dougherty, R. Souter introduced to clinical practice the term diastolic heart failure.

Diastolic heart failure (DSF) - clinical syndrome with symptoms and signs of heart failure, normal LV EF and impaired diastolic function.

Clinically, diastolic heart failure manifests itself as a slight limitation of physical activity (FC I according to the NYHA classification of the Association for the Study of Heart Disease) and the presence of symptoms at rest (FC IV).

Normal diastolic function of the left ventricle is its ability to "take" the volume of blood necessary to maintain adequate cardiac output, without an increase in mean pulmonary venous pressure (> 12 mm Hg). LV diastolic dysfunction occurs if the proper volume of blood can enter the LV only by increasing its filling pressure or if it is not able to increase filling during exercise and thereby provide an adequate increase in cardiac output. Any increase in LV filling pressure is always indicative of diastolic dysfunction. Almost all patients with systolic dysfunction of the left ventricle of the heart have violations of its diastolic function.

Diastole is limited by the time interval from the closure of the aortic valve to the closure of the mitral valve. Two key mechanisms occur in diastole - LV relaxation and filling. LV relaxation begins already in the second half of systole (during the period of slow blood ejection), reaches a maximum during the isovolumetric relaxation phase, and ends already during LV filling, which consists of phases of rapid filling, delayed filling (diastasis) and atrial systole.

LV diastolic function depends on the ability of the myocardium to relax, which depends on the functioning of the sarcoplasmic reticulum of cardiomyocytes.

The LV diastolic function also depends on the mechanical properties of the myocardium - elasticity (change in the length of muscle fibers depending on the force applied to them), compliance (change in ventricular volume for a given change in pressure) and stiffness (characteristic, inverse of compliance). Passive characteristics of the heart reflect the ability of the left ventricle to stretch as blood enters it.

At a young age, LV filling is due to a high pressure gradient at the beginning of diastole, which is formed by high speed relaxation and elastic properties myocardium. In this situation, the LV is mostly filled with blood in the first half of diastole.

Aging, hypertension, coronary artery disease lead to a significant slowdown in relaxation processes. In such a situation, the filling of the LV with blood occurs mainly not in the first half of diastole, but in the systole of the left atrium.

The diastolic function of the myocardium is significantly affected by the state (size, volume) of the left atrium, the speed of the transmitral blood flow and the number of heartbeats.

A change in the volume of blood entering the left atrium changes its contractility in full accordance with Starling's law. The increased force of left atrial contraction generates a shock jet that alters the LV filling rate and time-shifts subsequent phases, increasing myocardial stiffness. These changes are evident in AV block, high heart rate, and left atrial volume overload.

Symptoms and signs of diastolic dysfunction of the left stomach

Patients with diastolic heart failure present the same complaints as patients with heart failure - a feeling of lack of air, fatigue, palpitations.

In patients with diastolic heart failure, hypertension is more common and postinfarction cardiosclerosis is less common. Such patients are usually older than patients with systolic heart failure, and are often overweight. For patients with diastolic form of heart failure, atrial fibrillation is characteristic (among elderly patients - up to 75%).

In patients with diastolic heart failure, signs of venous congestion and associated symptoms (edema, wheezing in the lungs, swelling of the jugular veins, dyspnea) are less common than in patients with the classical, systolic form of the disease.

When auscultating patients with diastolic heart failure, 4 heart sounds can often be heard. Although the detection of the third heart sound is more typical for patients with systolic heart failure. With severe diastolic dysfunction, especially with a restrictive type of LV filling, this sign is found very often.

The largest clinical and epidemiological study of the clinical picture of circulatory failure - a study performed in the Russian Federation (EPOCHA-O-CHF) in 2001-2002.

The data obtained showed a trend towards an increase in the prevalence of diastolic heart failure over last years. Normal LV systolic function is recorded in 35-40% of patients with heart failure. The prevalence of diastolic heart failure varies with age. In patients under the age of 50 years, the diastolic form is diagnosed in 15% of patients, in those over 70 years old - already in 50% of patients.

The incidence of heart failure with normal LV systolic function depends on the severity of the examined patients and the criteria for assessing systolic function. Thus, among patients hospitalized with cardiac decompensation, normal LV EF is recorded in 20-30% of patients, and in terminal heart failure - in 5-10% of patients. At the same time, in outpatient practice, the prevalence of heart failure with normal LV systolic function, diagnosed using “soft” criteria (for example, based on an excess of ejection fraction by 40%), reaches 80%. Thus, as the severity of heart failure increases, the contribution of isolated diastolic dysfunction as the main cause of heart failure decreases.

Prognosis of diastolic heart failure

The frequency of repeated hospitalizations in patients with DHF and in patients with systolic insufficiency does not differ - approximately 50% per year.
Mortality in patients with DHF is 5-8% per year (with systolic circulatory failure - 15% per year). In recent years, there has been no decrease in the mortality rate in DHF.
Mortality in diastolic heart failure depends on the cause of HF, with its non-ischemic genesis - 3% per year.

Diagnostics of diastolic heart failure

The diagnosis of diastolic dysfunction is verified if the patient has 3 criteria.

Symptoms or signs of heart failure.
Normal or slightly reduced LV contractility (LV EF>45% and its end-diastolic size index<3,2 см/м 2).
Signs of impaired relaxation or filling of the left ventricle, its increased rigidity, obtained with instrumental research methods.

The basis for the diagnosis of diastolic heart failure is echocardiography.

Diastolic elevation of the base of the left ventricle. With diastolic dysfunction, the maximum velocity of the early diastolic rise of the LV base (E m) is below 8 cm/s. In addition, the ratio of the maximum wave velocities of the transmitral blood flow E and E >15 indicates an increased end-diastolic pressure in the left ventricle (>12 mm Hg), E/E m<8 - о нормальном, а при Е/Е m 8-15 необходимы дополнительные данные.

The commonly accepted biochemical marker for diastolic heart failure is the brain natriuretic peptide (NT-pro-BNP) precursor. Diastolic heart failure is characterized by an increase in the level of this peptide.

Treatment of diastolic heart failure

Treatment of myocardial ischemia. IHD is one of the main factors predisposing to diastolic disorders. These or other disorders of diastole are detected in more than 90% of patients with coronary artery disease. Improving diastolic function in conditions of coronary artery disease is possible with the use of drugs (β-acetrenoblockers, calcium antagonists) and measures for myocardial revascularization.

Treatment of arterial hypertension. In patients with hypertension, LV diastolic dysfunction is one of the earliest and most common manifestations of myocardial dysfunction, especially at the stage of myocardial hypertrophy. Normalization of blood pressure is one of the simple and at the same time effective ways to improve LV diastolic filling.

Decrease in LV filling pressure (reduction of its preload). The most important principle in the treatment of this condition is the reduction of LV preload (use of diuretics). An excessive reduction in preload dramatically reduces LV filling volume and reduces cardiac output. In these cases, the tactics of slowly reducing the preload on the left ventricle is justified. Taking diuretics is accompanied by excessive activation of the renin-angiotensin system, so it is advisable to combine them with blockers of the renin-angiotensin system (ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists).

Maintenance and / or restoration of sinus rhythm, preservation of the contractile function of the left atrium. The contractile function of the left atrium plays an important role in ensuring normal exercise tolerance in diastolic heart failure, the progression of which dramatically increases the risk of atrial fibrillation. With atrial fibrillation, the doctor chooses the tactics of "rhythm control" or "frequency control". Careful implementation of the requirements of the chosen tactics prevents the progression of diastolic heart failure.

Patients with diastolic heart failure should have target heart rate levels: with coronary artery disease - 55-60 per minute. With CHF, a decrease of 16% of the initial heart rate (80-84 per minute) is accompanied by a decrease in the risk of death. To reduce heart rate, β-blockers, phenylalkylamines, and If channel blockers are used.