Systolic vs Diastolic Heart Failure

Left-sided heart failure leads to fluid accumulation in the lungs and has an increased left ventricular end diastolic pressure (LVEDP). The left ventricular end diastolic volume (LVEDV) can either be increased or normal. When it is increased and the end systolic volume is also increased, this indicates systolic dysfunction. When the LVEDV is normal or the ejection fraction is normal, this indicates diastolic dysfunction.

Reminder:
Ejection fraction = Stroke Volume/End Diastolic Volume
Stroke Volume = End Diastolic Volume – End Systolic Volume

Systolic Heart Failure

The inability to expel sufficient blood, has a decreased ejection fraction. You might feel a displaced apical impulse or hear an S3.

Causes: Decreased contractility (ischemia, MI, chronic mitral regurg), Increased afterload (aortic stenosis, hypertensive crisis)

Diastolic Heart Failure

Failure to relax and fill normally, has a normal ejection fraction

Causes: Chronic hypertension, hypertrophic cardiomyopathy, aortic stenosis, coronary disease

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