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The Pathology of Systolic and
Diastolic Heart Failure
Kitty Kisslo, RDCS and David Adams, RDCS
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There are many ways to enter the progression of heart failure
(left). Most worrisome is the growth in hypertension and ischemia.
Then there is the vicious cycle of neurohormonal changes and
remodeling that leads to LV dilatation and death. Once symptomatic,
we worry that the process is very advanced.
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The most severe remodeling occurs in
dilated cardiomyopathy where the LV dilates and walls hypertrophy. |
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Echo sees these changes. |
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A very serious problem is the increase
in ischemia and infarction. Many times the ischemia is silent
and the last, and only, manifestation of coronary disease is
symptomatic heart failure. |
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In very advanced states of systolic failure
due to ischemia and infarction, there is scarring and wall thinning
(arrow). This is very severe remodeling. |
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The apex of patients with LV failure
is invariably very trabeculated, a relative wall thickening
in comparison to normal. This complicates the detection of small
thrombi, making differentiation of trabeculation from thrombus
impossible. Normal is at the upper left. The remainder are from
patients with systolic failure. Some experts think that these
apical changes represent remodeling.
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Diastolic failure always accompanies
LVH. On the right is a patient with hypertension. Diastolic
filling problems are present. |
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The echo on the right indicates LVH and
some form of filling abnormality and diastolic failure is certain. |
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HOCM is one of the worst forms of diastolic
filling abnormalities because of the severe LVH. |
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Again, echo sees these changes and the
LVH represents a form of remodeling. In these cases there is
no systolic failure. |
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The progression of heart failure as the
normal moves to LVH (diastolic failure) and then dilatation
(systolic AND diastolic failure). Relate these picture to the
first slide. |
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When valuvular disease is present, like
aortic stenosis it may lead to heart failure. |
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With severe aortic stenosis, there will
be progressive LVH and diastolic failure and ultimately dilation
and systolic failure. Invariably, every case of systolic failure
also has diastolic failure. |
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2004
