Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of
Systolic heart failure is a failure in the heart’s inability to adequately contract the blood into circulation.
Diastolic heart failure is far more prevalent in females and is characterized by an inability of the ventricles to adequately fill with enough blood volume. This decrease in stroke volume released into circulations will lead to decreased tissue perfusion throughout the body. The ventricles’ inability to properly fill is due to a decrease in the size of the chamber due to an enlargement in thickness of the myocardium in an attempt to push more blood from the heart (Lehne, 2010). The thickness causes the ventricles to become stiffer and not expand properly for filling. Diastolic HF essentially causes the blood to not be able to pump as much blood and causes back up of fluid into the atria and eventually the lungs, causing pulmonary edema. Pulmonary edema can, in turn, cause peripheral edema. Obesity can also play a role due to the fact that there is an increase in vasculature feeding this increase in body mass and the heart cannot adequately supply it with blood (Mayo Clinic, 2011). The heart is able to pump normally, but has less volume of blood to push out.
Heart failure causes the body to react with compensatory mechanisms to counteract the heart’s reduced cardiac output. These responses are activated to help the body cope, but essentially