Diastolic Dysfunction Heart Failure, Diagnostics, and Treatment

Diastolic cardiac insufficiency exists when signs and symptoms of heart failure are present, but the left ventricular systolic function is still preserved (ejection fraction above 45%). It is important to differentiate the diastolic from the systolic heart failure so that it can be optimally treated.

The incidence of diastolic heart failure increases with age; in about 50 percent of elderly patients with heart failure, there is isolated diastolic dysfunction, write Chhabi Satpathy and colleagues in the American Family Physician. If diastolic dysfunction is diagnosed early and adequately treated, the prognosis is better than for systolic dysfunction.

Diastolic heart failure is clinically and radiologically indistinguishable from systolic heart failure. However, if there is a normal ejection fraction and an abnormal diastolic function with signs and symptoms of heart failure, diastolic heart failure can be diagnosed. Unlike systolic, diastolic heart failure can occur in isolation. Common causes of diastolic dysfunction include cardiac ischemia, hypertension, aging, obesity and aortic stenosis. Rarely, the disorder is caused by myocardial diseases such as cardiomyopathy, storage diseases and amyloidosis or sarcoidosis or by a disease of the pericardium.

In isolated diastolic dysfunction, there is a disorder of isovolumic ventricular relaxation and decreased compliance of the left ventricle. The transmission of higher end-diastolic pressures into the pulmonary circulation can cause pulmonary congestion leading to dyspnea and eventually right heart failure.

diastolic-heart-failure-treatment

Diagnostics

Heart failure may be manifested by fatigue, exertional dyspnoea, paroxysmal nocturnal dyspnea, orthopnea, cervical venous stasis, rales, tachycardia, third or fourth heart sounds, hepatomegaly, and edema. Cardiomegaly and congestion of the pulmonary veins often occur in chest radiographs, but these findings are non-specific and can also occur in non-cardiac diseases. It is difficult to distinguish diastolic from systolic heart failure on the basis of physical examination alone.

Two-dimensional Doppler echocardiography is of great importance in the diagnosis of diastolic heart failure. This study not only provides important information about ventricular size, myocardium, heart valves, systolic function and pericardium, but also provides information on diastolic transmitral and pulmonary venous blood flow. In echocardiography, the peak velocity of blood flow through the mitral valve in the early diastolic filling phase corresponds to the e-wave. The atrial contraction corresponds to the A-wave. From these values, the I / O quotient is calculated. Usually E is greater than A, and the I / O ratio is about 1.5.

In early diastolic dysfunction, relaxation is disturbed and the I / O ratio drops to less than 1.0 with atrial contraction. As the disease progresses, left ventricular compliance decreases, increasing left atrial pressure and early left ventricular filling despite disturbed relaxation. This paradoxical normalization of the I / O quotient is called “pseudo-normalization”. In patients with severe diastolic dysfunction, the left ventricle is filled, especially in early diastole, resulting in an I / O ratio above 2.0. Although cardiac catheterization is preferred in the diagnosis of diastolic dysfunction. However, two-dimensional Doppler echocardiography has proven to be the best noninvasive method in everyday clinical practice. Rarely, radionuclide angiography is performed, especially in patients who find echocardiography technically difficult.

Treatment

Primary prevention of diastolic heart failure includes nicotine abstinence and the aggressive treatment of high blood pressure, hypercholesterolemia and coronary heart disease. Lifestyle changes such as weight loss, cessation of smoking, diet change, restriction of alcohol intake and physical activity serve to prevent diastolic and systolic heart failure. Diastolic dysfunction can remain asymptomatic for many years. Early diagnosis and treatment are important to prevent irreversible structural changes and systolic dysfunction. At first glance, it seems that the treatment of diastolic and systolic heart failure is not very different. However, the treatment of diastolic heart failure is limited due to the lack of large randomized controlled trials. In addition, optimal treatment for systolic heart failure may result in exacerbation of diastolic heart failure.

Improvement of the left ventricular function

For diastolic dysfunction, it is important to control the heart rate and prevent tachycardia to maximize the diastolic filling period. Beta-blockers are particularly useful for this purpose, but they do not directly affect myocardial relaxation. Beta blockers should be used in particular for the treatment of diastolic heart failure, if a high blood pressure, coronary heart disease or arrhythmia.

Optimization of hemodynamics

Hemodynamic optimization is achieved primarily by reducing cardiac preload and afterload. ACE inhibitors and angiotensin receptor blockers directly affect myocardial relaxation and compliance by inhibiting the formation of angiotensin II or blocking angiotensin II receptors, thus preventing interstitial collagen deposition and fibrosis. A Hemodynamic optimization also results in better filling of the left ventricle. and lowering blood pressure. In addition, there is an improvement in exercise capacity and quality of life.

Diuretics may provide optimal intravascular volume in diastolic dysfunction patients, minimize dyspnoea, and prevent acute heart failure. Although diuretics control blood pressure, lead to regression of left ventricular hypertrophy and reduce left ventricular stiffness, some patients with diastolic heart failure are sensitive to preload and develop hypotension or severe prerenal azotemia.

The hormone aldosterone promotes cardiac fibrosis. The aldosterone antagonist spironolactone (Aldactone® or generic) has been studied in a large clinical trial in patients with systolic heart failure. There has been a reduction in heart failure-associated mortality, but the specific effects of spironolactone on diastolic dysfunction are unclear.

Calcium antagonists directly improve diastolic function through myocardial relaxation and indirectly by lowering blood pressure and heart rate, reducing myocardial ischemia, and promoting regression of left ventricular hypertrophy. However, non-dihydropyridine-type calcium antagonists such as verapamil (Isoptin® or generics) and diltiazem (Dilzem® or generic) should not be used in patients with left ventricular dysfunction. Long-acting dihydropyridines such as amlodipine (Norvasc® or generic) should only be used to control heart rate and angina pectoris, If beta blockers are contraindicated or ineffective.

Vasodilators such as nitrates and hydralazine may be useful because of their anti-ischemic and preloading effects, especially if ACE inhibitors can not be used. However, vasodilators should be used with caution as a reduction in preload may reduce cardiac output.

Heart Valve Disease Symptoms And Treatment

Heart valve disease can affect any of the valves in the heart. The heart valves have flaps for opening and closing with each heartbeat, allowing blood to flow through the heart of the upper and lower chambers and the rest of the body.

The heart has four valves :

    1. Tricuspid valve located between the right atrium and the right ventricle
    2. Pulmonary valve located between the right atrium and the pulmonary artery
    3. Mitral valve, which is located between the left atrium, and left ventricle
    4. Aortic valve between the left ventricle and the aorta

Blood flows from the right and left atria across the tricuspid and mitral valve, allowing the blood to flow into the right and left ventricles. These valves then close the blood flowing back into the atria. Once the heart chambers are filled with blood, they begin to contract, forcing the lung and aortic valves to open. Blood then flows into the pulmonary artery and the aorta. The pulmonary artery carries oxygenated blood from the heart to the lungs and the aorta, the body’s largest artery, is responsible for carrying oxygen-rich blood to the rest of the body.

Basically, the heart valves work by making sure that blood flows in the forward direction and does not secure or leaks. If an individual has a valvular disease, the valve will not be able to do this job properly. This can be caused by regurgitation, stenosis or a combination of both.

Some individuals may experience no symptoms while other disorders such as strokes, heart attacks and thrombosis occur when the heart valve disease is left untreated.

valvular-heart-disease

Valvular heart disease

Mitral valve prolapse

This can also be called floppy valve syndrome, click marbles syndrome, balloon mitral valve or Barlow syndrome. It occurs when the mitral valve does not close properly, sometimes causing blood to flow back into the left atrium.

Most people with mitral valve prolapse do not require symptoms and no treatment as a result. However, symptoms such as palpitations, shortness of breath, chest pain, fatigue and coughing may indicate that treatment is necessary.

The treatment includes surgery to repair or replace the mitral valve.

Bicuspid aortic veins

This happens when a person is born with an aortic valve that has two valves instead of the usual three. In very severe cases, symptoms of this type of disorder are present at birth. However, some people may know that they have decades to go without this type of disorder. The valve is usually able to work for years without causing any symptoms, so most people with premolar aortic valve disease are usually diagnosed only in adulthood. According to the Cleveland Clinic, 80 percent of people with this form of heart valve disease will be operated to repair or replace the valve, which usually happens when they are in their 30s or 40s.

Symptoms include shortness of breath during exercise, chest pain and dizziness or fainting. Most people are able to successfully repair their aortic valve with surgery.

Valvular

This occurs when a valve is unable to fully open, which means that insufficient blood is able to flow through the valve. This can affect one of the heart valves, and can be caused by the heart valve thickening or stiffening.

Symptoms can include chest pain, shortness of breath, tiredness, dizziness and fainting. Some people do not need treatment. Other people may use valvuloplasty, which uses a balloon to inflate the valve or flap replacement surgery.

Valve insufficiency

This can also be called a “leaky valve” and occurs when one of the heart valves does not close properly, causing the blood to flow backwards. Symptoms include shortness of breath, coughing, tiredness, palpitations, drowsiness and swelling of the feet and ankles.

The effects of valve failure vary from person to person. Some people need to monitor their condition. Others may need prescribed medications to prevent fluid retention while others have valve repair or replacement.

heart-valve-disease-symptoms

Causes Of Valvular Heart Disease

There are a number of causes of various heart valve diseases. Causes can be :

    • birth defect
    • Endocarditis inflammation of the heart tissue
    • Rheumatic fever inflammatory disease brought on after group A streptococcal infection
    • Age-related changes, such as calcification
    • Heart attack
    • coronary artery disease
    • Cardiomyopathy degenerative changes in the heart muscle
    • Syphilis is a relatively rare sexually transmitted infection
    • hypertension
    • Aortic aneurysms abnormal swelling or protrusion of the aorta
    • Atherosclerosis Arteriosclerosis
    • myxomatous degeneration weakening of the connective tissue in the mitral valve
    • Lupus a chronic autoimmune disease,

Heart Valve Disease Symptoms

Symptoms of heart valve disorders according to the severity of the disease. Usually, the onset of symptoms indicates that the disorder is affecting blood flow. Many people with mild or moderate valvular heart disease experience no symptoms. However, symptoms can be :

    • shortness of breath
    • palpitation
    • fatigue
    • Chest pain
    • Dizziness and fainting
    • a headache
    • to cough
    • Water retention or swelling in the lower extremities and abdomen
    • Pulmonary edema or excess fluid in the lungs
How are heart valve diseases diagnosed?

If you have symptoms of heart valve disease, your doctor will start by listening to the heart using a stethoscope. He or she will listen for any heart rate abnormalities that might indicate a problem with the heart valves. Your doctor may also listen to the lungs to determine if there is fluid retention as well as check your body for signs of water retention, both symptoms of heart valve problems.

Other tests that can diagnose for valvular heart disease include :

    • Electrocardiogram is a test that shows the electrical activity of the heart. This test is used to check arrhythmia.
    • Echocardiography uses sound waves to create an image of the heart valves and chambers.
    • Cardiac catheterization is another test to diagnose valve disorders. This test uses a thin tube or catheter with a camera to take pictures of the heart and blood vessels. This can help to determine with your doctor the nature and severity of the disease valve.
    • A chest x-ray can be ordered to take a picture of your heart. This may be your doctor if your heart is enlarged.

Magnetic resonance imaging can create a more detailed picture of the heart. This can help to confirm a diagnosis and help your doctor determine how best to treat your valve disorder.

A stress test can also be used to determine how the symptoms are affected by physical exertion. The information from the stress test can help your doctor determine the severity of your condition.

Treatment Options

Treatments for heart valve disorders depend on the severity of the disease and symptoms. Most doctors recommend starting with conservative treatment. This includes :

    • consistent medical supervision
    • smoking
    • a healthy diet

Medications that are usually prescribed are :

    • Beta blocker and calcium channel blocker to help control heart rate and blood flow
    • Reduce diuretics for fluid retention
    • vasodilating drugs that open or dilate the blood vessels

Surgery may be needed if the symptoms increase in severity. This can be used to repair heart valves with patient’s own tissues or heart valve replacement with animal valves, donated valves, mechanical or valves.

Valvuloplasty can also treat the stenosis. A small balloon inserted into the heart, where it is slightly puffed up. The inflation will be the size of the opening in the valve and then the balloon is removed.

What Are The Most Common Stent Heart Side Effects?

Stents are small tubes that are suitable in arteries or ducts to keep them open when compromised. There are a variety of stents designed for various procedures and applications. Some of the procedures include the use of coronary, esophageal, ureteral and biliary stents. Most of them are made of stainless mesh and plastic steel; however, there are other stents that act as transplants and these are made from a special tissue. There are a number of common stent heart side effects that can occur and these could include clotting, calcification, bleeding and pain.

There are two types of stent heart that are typically used: bare mesh stents and stents that have been coated with a drug. These are referred to as drug-eluting stents and are used to prevent the arteries from restarting. These devices are usually more effective and save lives; however, there are cases where patients experience negative results. Clinical studies using wire mesh stents in the cerebral arteries found that the stents caused strokes in patients. Stent Side Effects When performing procedures for coronary heart blockage can sometimes cause chest pain, swelling of the arms or legs, and bleeding from the puncture site on the groin.

 

Uretal stents placed to allow urine to travel unhindered from the kidney to the bladder, sometimes irritate the bladder and cause pain to the back and groin areas. They can be moved from place and wandering in the bladder causing the patient to frequent urination and possibly cause blood to enter the urine. Physical activity can also cause the stent heart to move. Sometimes drug side effects can be lessened, and in most cases, they disappear when the stent is removed. Doctors recommend that patients with constant and severe pain or fever as a result of a stent should seek immediate medical attention.

Patients with stents Side effects of devices with medications sometimes present with blood clots, and in some cases allergic reactions to the stent itself coated. This is usually treated with medication; however, scarring at the site of the stent heart can be a common side effect. Medication-coated stents can also cause gastrointestinal bleeding, flu-like symptoms, chest pain and strokes. Studies have shown that these symptoms and effects can also occur in nude mesh stents, yet appear to be more potent in medical devices. Although not as common, other stent side effects are lung disease and even cancer.

    • A stent heart is a supporting device introduced into the body.
    • While recovering from the surgery, patients need to be careful to sit upright while eating to ensure food goes through the stent.
    • Stents are used to keep blood vessels free of blockages.
    • Blood clotting, calcification, bleeding and pain are among possible side effects of using stents in coronary artery procedures.
    • Some stent heart side effects in the treatment of coronary blockages can cause chest pain.

Benefits and Nutritional Value Of Almond Milk

Almonds are known to most people in the form of sweet marzipan or as part of cakes and pastries. Also candied or salted almonds are popular as a snack in between. Not quite so widespread is the knowledge of the nutritional importance and the diversity that lies in the nutritious kernels!

Not only can almonds be processed into liqueurs, puddings, spreads and delicious dessert sauces. Even as almond milk, the core of the inconspicuous drupe is becoming increasingly important. For people with protein intolerance and lactose intolerance or for vegans, it is therefore an ideal alternative to the supposedly indispensable cow’s milk.

Simply make almond milk yourself

To produce the versatile almond milk only a part of almonds and two parts of water are needed as starting raw materials. From 250 grams of almonds and 500 milliliters of water can thus produce 750 milliliters of almond milk. The almonds can be pre-soaked overnight and then skinned. For a sweeter flavor provide pitted dates.

Almonds and dates are minced with food processor, blender or blender to a fine pulp and mixed with the appropriate amount of water. If the mixture shows a milky-white, homogeneous texture, almond milk can be passed through a fine sieve or cloth to strain the solid ingredients. Afterwards, the almond milk is ready for immediate consumption or further processing as desired.

Nutritional-Value-Of-Almond-Milk

Possible uses of almond milk

Whether vegans, allergy sufferers or people with special nutritional requirements: almond milk enriches every menu in a variety and healthy way, because basically the milk from the almond can be used as well as their “animal” counterpart. Milk shakes, desserts and mueslis can be prepared from almond milk, as well as fruit shakes, yoghurt variations and sweet creams, and even coffee makes almond milk an aromatic treat.

For the preparation of delicious milk drinks almond milk can be mixed with commercial drinking cocoa or flavored with cinnamon or natural vanilla. But not only sweet delicacies can be made from the almond milk. Spicy dips, white herbal or “cream sauces” and even almond milk aioli are also possible. When used for savory dishes almond milk can also be used in unsweetened form.

Benefits of almond milk compared to cow’s milk

Although cow’s milk is quite healthy. In highly processed form, however, many dairy products today are sweetened too much or provided with artificial flavors, dyes and other additives.

Also, the basis of our modern dairy production – factory farming – raises ethical questions that are driving more and more people to consciously avoid cow’s milk. Last but not least, one’s own well-being forces many people to avoid cow’s milk. Whether lactose intolerance or protein allergy – even in the context of a dietary diet, almond milk is a tasty and wholesome alternative.

Thus, the dates used as a “sweetener” are more digestible than lactose and provide not only fast energy but also vital ingredients such as iron, phosphorus, zinc, magnesium, copper and various minerals that support the body’s metabolism.

As a purely herbal product, almond milk also contains no saturated fatty acids, but simply or polyunsaturated fatty acids, such as omega 6 and omega 9. In addition, the amino acids contained are optimally absorbed by the body and help build muscle and tissue.

As an unencumbered natural product, it is much more than just a “milk substitute”!