Understanding "Diastolic Heart Failure"The Tip of the Iceberg*
Rick A. Nishimura, MD, FACC* and
Wissam Jaber, MD
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
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Figure 1 Pressure Tracings From 2 Different Patients With HFnlEF
Patient A has hypertensive heart disease and patient B has nonobstructive hypertrophic cardiomyopathy. The tracings on the left are recorded at baseline; those on the right are after intravenous nitroprusside (patient A) and intracoronary enalaprilat (patient B). The pulmonary capillary wedge and the left ventricular (LV) end-diastolic pressures decreased in patient A because of a decrease in LV systolic pressure. This is in contrast to patient B, in whom the left atrial (LA) and LV end-diastolic pressures dropped without a significant change in the LV systolic pressure. These examples implicate the presence of different underlying pathophysiologic mechanisms responsible for increased diastolic filling pressures in patients with heart failure with normal ejection fraction (HFnlEF). PCWP = pulmonary capillary wedge pressure.
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