DIFFERENTIATION BETWEEN SYSTOLIC AND DIASTOLIC DYSFUNCTION

Left ventricular (LV) failure can be divided into systolic and diastol ic dysfunction. The former is characterized by a reduced ejection frac tion and an enlarged LV chamber, the latter by an increased resistance to filling with increased filling pressures. Systolic dysfunction is clinically associated with left ventricular failure in the presence of marked cardiomegaly, while diastolic dysfunction is accompanied by pu lmonary congestion together with a normal or only slightly enlarged ve ntricle. Echocardiography is currently the most relevant technique for non-invasive differentiation of the two forms. Systolic dysfunction i s easily assessable by estimation of global ejection fraction and regi onal wall motion. Diastolic dysfunction can be diagnosed indirectly by means of a normal or nearly normal ejection fraction and changes of t he mitral filling pattern in the context of LV failure. For an exact d etermination of diastolic dysfunction LV catheterization is required. Systolic dysfunction treatment is well defined, consisting of ACE inhi bitors, followed by diuretics and digitalis. Calcium channel blockers are usually contraindicated. Diastolic dysfunction therapy is more dep endent on the underlying disease. Calcium channel blockers, ACE inhibi tors or beta-blockers are first line drugs in most instances: diuretic s can be added with increasing symptoms. Digitalis should be avoided, except in atrial fibrillation, to control heart rate.