SYSTOLIC DYSFUNCTION

Above you see a chart related to diastolic and systolic dysfunction in heart failure.  On this page we will be focusing on Systolic Dysfunction.  This is a very involved topic and we will only be giving you an introduction to the disease.

In systolic dysfunction there is impairment in the contraction of the ventrical.  This is often caused by decreased contractility of the ventrical.  Ejection fraction is evaluated to diagnose systolic dysfunction versus diastolic dysfunction.

A variety of medications may be used for the treatment of systolic dysfunction.  These include ACE Inhibitors (angiotensin-converting-enzyme) for all patients that can tolerate them.  ARBs (angiotensin receptor blockers) can be used as a substitute for patients that cannot tolerate taking ACE Inhibitors.  Beta-blockers are used in patients that are hemodynamically  stable.  Aldosterone antagonists in low dose are used for patients that have dyspnea at rest.  Diuretics are used with symptomatic patients to maintain appropriate fluid balance.  Digoxin is used in patients that remain symptomatic despite the use of all of the previous medications.  Another section of the web site will go into
more detail regarding the different types of medications used to treat heart failure.

Another type of treatment used with patients with systolic dysfunction is the placement of implantable defibrillators which function as a prophylaxis against sudden cardiac death from ventricular tachycardia/ventricular fibrillation in patients with an ejection fraction less than 35%.  Also Bi-ventricular pacemakers are considered for patients requiring defibrillators who have symptomatic heart failure and an intraventricular conduction defect.  Bi-ventricular pacemakers are discussed in another section of this site.  The useof bi-ventricular pacemakers is also referred to as resynchronization therapy.

Coronary artery disease producing ischemic cardiomyopathy is the most common cause of left ventricular systolic dysfunction.

Heart failure often has the first symptom of dyspnea with exertion or lying flat.  These patients also often have dependent edema and fatigue.  Arrhythmias causing palpitations and dizziness can be the initial manifestations of the disease.

Diagnostic studies used to diagnose heart failure with systolic dysfunction:

     EKG’s can help determine whether ischemic heart disease is present.  A majority of
     patients with systolic dysfunction have ischemic heart disease.    

     Echocardiography can measure ejection fraction.  Patients that are suspected of having
     heart failure should have an Echo to assess systolic function.

     Cardiac catheterization is done to evaluate the patient for the presence of coronary
     artery disease as patients with systolic dysfunction often have ischemic heart disease.

     BNP levels have been found to be useful in the diagnosis and prognosis of patients
     with heart failure.  BNP levels though do not differentiate between systolic and
     diastolic dysfunction.