can be described as the following and a couple
of things that you want to pay attention here.
So please follow me.
We will begin with the left ventricle.
The most common side of the heart to be affected
would be the left side as you know. Now with
CHF, you then divide it into systolic or diastolic
dysfunction depending as to what then led
up into that particular type of failure. Take
your time. If it is systolic dysfunction,
I am having a hard time ejecting. If you have
a hard time ejecting meaning to say that you
can’t contract your heart. How does it occur?
Maybe there was a myocardial infarction resulting
in ischemia obviously. And so therefore
the heart no longer fully recovers its normal
action, activity, and function, may result
in a systolic dysfunction. Is that clear?
When you have a systolic type of dysfunction,
you should automatically think and be looking
at clinically at least to the point where
you know that your left ventricle has been
enlarged probably underwent eccentric hypertrophy
and PMI was probably what? Laterally displaced.
Versus a diastolic dysfunction. Now a systolic
dysfunction if I can’t even eject the blood
forward, what is the test that you are going
to measure in which the blood gets ejected
or not? It is called ejection fraction. What
is that equal? It equals your stroke volume
over your EDV. What is your stroke volume?
It is the EDV minus ESV/EDV. That is your ejection
fraction. It is a fraction, you got a percentage
and that would be 55 percent. If it is systolic
dysfunction, your ejection fraction plummets
immediately. You know without a doubt that
your patient has heart failure. Now that is
the easy diagnosis. The one that you want
to be a little bit more careful is based on
history. Everything is based on history. With
diastolic dysfunction, it is a very thick
left ventricle or maybe perhaps there is too
much blood in your left ventricle. Let us
deal with the one in which your left ventricular
wall is thickened secondary to pressure.
Where does this pressure come from?
Most commonly hypertension. And what kind of
change, what kind of hypertrophy would you
have in your left ventricle? Concentric hypertrophy
resulting in decreased chamber size. So, therefore,
you cannot properly fill up your left ventricle.
What do we have ladies and gentleman? A diastolic
dysfunction. Early on in hypertension, aortic
stenosis, which would still be what? A pressure
overload type of defect. Where? On your left ventricle.
Is it possible early on that
you may be able to properly preserve ejection
fraction? Yes, you can. You can preserve your
ejection fraction. Welcome to HF, heart failure.
P is preservation. EF is ejection fraction.
That is what the abbreviation means that which you
are going to use clinically. Walk into any
cardiac clinic and you tell them exactly what
I told you, you will be a star. And once you
make that first impression, that is it.
No one is going to doubt you.
Next, right ventricle. Most common cause of
right heart failure, RHF is LHF, which is
left-sided heart failure. May I ask you this
one more time? Is this cor pulmonale? You
will tell me confidently, no. If you haven't,
you do now. If you have primarily a lung disease,
then you have right-sided heart failure, then
you call this cor pulmonale. Pressure-volume
overload right ventricle from the overload
of the LV. We talked about this a few times
and if you get into a right ventricular failure
that is not good news for the patient. Is
that clear? Bad prognosis. Biventricular,
obviously both ventricles are going to die.
So you pay attention left ventricular failure
first. Make sure you know firmly the difference
between systolic and diastolic dysfunction.
Once you get that down, right ventricular
failure pretty straightforward, and then biventricular
when both ventricles are going to die.