Pathophysiology of heart failure

A. HF is defined as insufficient cardiac function to supply the metabolic demands of the body. Systolic dysfunction produces ventricular dilation with poor contractile function.

B. Impaired ventricular filling, or diastolic dysfunction, is common, especially in elderly hypertensive patients, and may be seen in 30% of patients who have clinical evidence of HF. It is characterized by ventricular hypertrophy, with preserved cardiac contractility. Impaired diastolic filling leads to a reduction in stroke volume and a corresponding reduction in cardiac output. Routine echocardiography is required in any patient with new-onset HF, since measurement of left ventricular function helps differentiate systolic from diastolic dysfunction.

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