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Feature Article

Diastolic heart failure in the elderly

Danny Liew, Henry Krum

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Abstract

Diastolic dysfunction can coexist with systolic dysfunction, but a significant proportion of patients with clinical features of heart failure have isolated diastolic dysfunction. Differences in management mean that it is necessary to distinguish between the two types of ventricular failure.

Key Points

  • Diastolic dysfunction is common, especially in elderly patients, and can coexist with systolic dysfunction.
  • Systemic hypertension and coronary heart disease are the most common causes of diastolic dysfunction in elderly patients, occurring against a background of age-related changes in myocardial compliance.
  • The gold standard for diagnosis of diastolic function is direct assessment via cardiac catheterisation and haemodynamic studies. However, several noninvasive techniques are available – the most convenient and commonly used of these is Doppler echocardiography.
  • At present, data from large randomised trials are not available for the pharmacological treatment of diastolic heart failure.
  • Control of aetiological factors, particularly hypertension, coronary heart disease and arrhythmias, constitutes the mainstay of management of diastolic heart failure.
  • Diuretics are effective in reducing pulmonary congestion and provide symptomatic relief, but must be used judiciously.
  • Beta blockers, rate-limiting calcium channel antagonists and ACE inhibitors (or angiotensin II antagonists if there is true intolerance to ACE inhibitors) may be used to improve ventricular filling and/or retard ventricular remodelling. The choice of agent (or agents) should also be determined by comorbid conditions.

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