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  • Image not available.Diastolic heart failure is a frequent cause of heart failure (35–50% prevalence) and has a significant effect on mortality (25–35% 5-year mortality rate) and morbidity (50% 1-year readmission rate).
  • Image not available.Hypertension is a common cause of diastolic heart failure.
  • Image not available. The diagnosis of diastolic heart failure can be made when a patient has both symptoms and signs of congestive heart failure on physical examination and preserved left ventricular (LV) function.
  • Image not available. Treatment should be targeted at symptom reduction, causal clinical disease, and underlying basic mechanisms. Patients with diastolic heart failure may be treated differently than those with systolic dysfunction.
  • Image not available. Nonpharmacologic treatment measures include weight loss, smoking cessation, dietary changes, and exercise.
  • Image not available. Symptom-targeted therapy includes decreasing pulmonary venous pressure, maintaining atrial contraction and atrioventricular synchrony, and reducing heart rate. Exercise tolerance is increased by reducing exercise-induced increases in blood pressure and heart rate.
  • Image not available. Disease-targeted therapy includes preventing or treating myocardial ischemia and preventing or regressing LV hypertrophy.
  • Image not available. Treatment strategies for patients with hypertrophc cardiomyopathy (HCM) are aimed at improving symptoms and preventing sudden cardiac death.
  • Image not available. Patients with HCM who are at high risk for sudden cardiac death should receive an implantable cardioverter-defibrillator.
  • Image not available. Patients with HCM who are symptomatic may benefit from β-blockade or verapamil.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Describe the underlying pathogenesis of diastolic heart failure.
  • 2. Relate the underlying pathogenesis of diastolic heart failure to the clinical symptoms.
  • 3. Select the appropriate currently available clinical tool to differentiate diastolic heart failure from systolic heart failure.
  • 4. Assess the contribution of concomitant medical problems to the development or clinical presentation of diastolic heart failure.
  • 5. Describe the clinical manifestations of diastolic heart failure.
  • 6. Compare and contrast the clinical manifestations of diastolic heart failure with those of systolic heart failure.
  • 7. Determine the desired outcomes of treatment in patients with diastolic heart failure.
  • 8. Design a nonpharmacologic plan for the management of diastolic heart failure.
  • 9. Debate the usefulness of digoxin in patients with diastolic heart failure.
  • 10. Delineate the role of β-blockers, calcium channel blockers, angiotensin receptor blockers, and ACE inhibitors in patients with diastolic heart failure.
  • 11. Recommend a pharmacologic treatment plan for a patient with diastolic heart failure.
  • 12. Prepare a treatment plan for a patient with diastolic heart failure and atrial fibrillation.
  • 13. Compare the pathophysiologic manifestations and clinical presentation of dilated cardiomyopathy with those of hypertrophic cardiomyopathy.
  • 14. Evaluate patients with hypertrophic cardiomyopathy at high risk for sudden death, and select those who would benefit from receiving an implantable cardioverter-defibrillator.
  • 15. Determine which patients with hypertrophic cardiomyopathy would benefit from surgical therapy.
  • 16. Differentiate the dose of β-blockers when initiating treatment for hypertrophic cardiomyopathy compared with systolic heart failure.
  • 17. Select the most appropriate calcium channel blocker when managing the patient with hypertrophic cardiomyopathy.

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Heart failure (HF) may be caused by a primary abnormality in systolic function, diastolic function, or both. Making the distinction is important because ...

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