A 43-year-old African American woman presents to her family physician for a routine examination. Past medical history is positive for amyloidosis and non-rhythm-based cardiac abnormalities secondary to the amyloidosis. Which of the following cardiac parameters would be expected in this patient?
1.Preserved ejection and increased compliance
2.Preserved ejection fraction and decreased compliance
3.Decreased ejection fraction and increased compliance
4.Decreased ejection fraction and decreased compliance
5.Increased ejection fraction and decreased compliance
sol:
This patient has diastolic heart failure secondary to amyloidosis. Diastolic heart failure is characterized by a decrease in ventricular compliance with normal contractility (preserved ejection fraction).
Diastolic heart failure is a form of heart failure that is seen when various conditions lead to ventricular stiffening. When the heart is unable to completely relax and fill during diastole, compliance is reduced and end diastolic pressure is increased. However, even though the compliance is reduced, the contractility of the heart is not affected, and the ejection fraction is preserved in these patients. Conditions that can cause diastolic heart failure include: hypertension with LVH, hypertrophic cardiomyopathy, amyloidosis, sarcoidosis, hemochromatosis, scleroderma, and even post-operative and radiation fibrosis.
Satpathy et al. discuss the management and diagnosis of diastolic heart dysfunction. They describe diastolic heart dysfunction as a clinical condition that presents with classic CHF findings in addition to abnormal diastolic and normal systolic function. Physical findings alone are not able to distinguish systolic versus diastolic heart failure. Treatment includes controlling blood pressure and heart rate, in addition to decreasing blood volume and myocardial ischemia.
Meier-Ewert et al. report on the diagnosis and management of cardiac amyloidosis. Amyloidoses are disorders that are characterized by the deposition of misfolded proteins into various organs, which can lead to their dysfunction. Cardiac involvement leads to increased wall thickness and impairment in cardiac cycle properties. Treatment includes diuretics, amiodarone, and warfarin.
Illustration A depicts the differences between diastolic and systolic types of heart failure. Systolic heart failure can be described as thin and weak ventricles, which cause an impaired ability to appropriately pump blood.