Combined Ventricular Systolic and Diastolic Dysfunction
It is not uncommon in chronic heart failure to have a combination of both
systolic and
diastolic
dysfunction. Therefore, the slope of the
end-systolic
pressure-volume relationship (ESPVR) is decreased and the slope of the passive
filling curve (reciprocal of compliance) is increased in the ventricular
pressure-volume loop shown to the right. When this occurs, there is a
dramatic reduction in stroke volume because end-systolic volume is increased and
end-diastolic volume are decreased. Both
ejection fraction
and
stroke work are also decreased.
This combination of systolic and diastolic dysfunction, coupled with
compensatory volume expansion, can lead to very high
end-diastolic pressures that can cause pulmonary congestion and edema,
as well as systemic edema and ascites (particularly when the right
ventricle is in failure). Therefore,
diuretic drugs
are commonly used in these patients.
Revised 04/06/07
