LEFT-VENTRICULAR FAILURE - SYSTOLIC VS DI ASTOLIC DYSFUNCTION

Left ventricular failure has been subdivided into different forms. Sys tolic pump failure (= systolic dysfunction) and diastolic filling fail ure (= diastolic dysfunction) are important entities in the overall fr amework of heart failure. The clinical patterns of both are presented in light of 2 case reports: systolic dysfunction involves the combinat ion of left ventricular failure, cardiomegaly and depressed systolic e jection fraction. Diastolic dysfunction is accompanied by pulmonary co ngestion in the presence of a normal or only slightly enlarged ventric le and a normal ejection fraction. Prognosis of systolic dysfunction i s poor, with a 5-year survival rate of 40%, compared to 70% in patient s with isolated diastolic dysfunction. Medical treatment of systolic d ysfunction is based primarly on ACE-inhibitors followed by diuretics a nd digitalis. Betablockers in low doses and spironolactone can provide additional benefit. Calcium channel blockers are rarely indicated, du e to their negative inotropic effects. In patients with diastolic dysf unction, however, they are the first choice because of their positive lusitropic effect on relaxation and ventricular filling. ACE-inhibitor s are suitable in hypertensive heart disease, while diuretics and beta blockers are second line drugs. Digitalis should be avoided since wors ening of diastolic function may occur.