Systolic vs Diastolic Heart Failure and Cardiomyopathy (BZ)

Two major types of cardiomyopathy are dilated or hypertrophic cardiomyopathy. Both lead to a difficulty ejecting blood into the periphery, but they have different causes, pathogenesis and physical exam features. All cardiomyopathies have the possibility of leading to heart failure if it reaches the point where the body cannot meet the body’s circulatory demands. Congestive heart failure can be subdivided into systolic or diastolic, meaning the heart has difficulty contracting versus relaxing. It is no surprise that dilated cardiomyopathies lead to systolic heart failure, problems with relaxation, and hypertrophic cardiomyopathy leads to diastolic heart failure, problems with relaxation.

The treatments are very similar and are often so closely related terms are sometimes used interchangeably. For dilated cardiomyopathy patients often present with shortness of breath, especially when lying down, and peripheral edema if the cardiomyopathy developed slowly. For hypertrophic cardiomyopathy patients often present at a young age since this is a genetic disease, and have symptoms of syncope with physical exertion.

Long-term cardiomyopathies can lead to heart failure. Heart failure presents both chronically or acutely. In chronic heart failure presentation is similar to dilated cardiomyopathy: shortness of breath, orthopnea, peripheral edema, etc. In an acute decompensated state of heart failure, the patient presents with acute shortness of breath, often pulmonary edema and elevated jugular venous pressure. All situations are treated very similarly with minor differences, excluding hypertrophic cardiomyopathy, which is covered in more detail in another lecture.

For chronic heart failure and dilated cardiomyopathy treatment includes decreasing the workload on the heart: sodium restriction, diuretics, ACE inhibitors and beta-blockers, and also increasing the contractility of the heart: digitalis. In acute decompensated heart failure treatment should still focus on decreasing the workload on the heart, but beta-blockers should be used with caution due to the fact that they are negatively ionotropic meaning they may dampen the hearts ability to contract. Common presentations, causes, diagnostic criteria, treatment and case files are discussed in this video.

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