Combined sys-dias dysfunction

    Cardiovascular Physiology Concepts
                                    Richard E. Klabunde, Ph.D.

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Topics:

Arrhythmias

Cardiac Valve Disease

Coronary Artery Disease

Edema

Heart Failure

Hypertension

Peripheral Artery Disease

Click here for information on Cardiovascular Physiology Concepts, published by Lippincott Williams & Wilkins (200 5)

Combined Systolic and Diastolic Dysfunction

It is not uncommon in chronic heart failure to have a combination of both systolic and diastolic dysfunction. Therefore, the slope of the end-systolic pressure-volume relationship (ESPVR) is decreased and the slope of the passive filling curve (reciprocal of compliance) is increased in the ventricular pressure-volume loop shown to the right. When this occurs, there is a dramatic reduction in stroke volume because end-systolic volume is increased and end-diastolic volume are decreased. Both ejection fraction and stroke work are also decreased.

This combination of systolic and diastolic dysfunction, coupled with compensatory volume expansion, can lead to very high end-diastolic pressures that can cause pulmonary congestion and edema, as well as systemic edema and ascites (particularly when the right ventricle is in failure). Therefore, diuretic drugs are commonly used in these patients.

RK Revised 04/06/07

DISCLAIMER: These materials are for educational purposes only, and are not a source of medical decision-making advice.