Chronic Heart Failure

Systolic Dysfunction

Involves inadequate ventricular contraction. This results in reduced ejection fraction. This condition can affect either the left ventricle or the right ventricle. Left ventricular failure almost always leads to right ventricular failure eventually.

Causes Include:

• Myocardial infarction
• Mycarditis
• Dilated Cardiomyopathy

Signs & Symptoms:

• Left Ventricular Failure:
  • Pulmonary edema
• Right Ventricular Failure:
  • Peripheral edema
  • Liver dysfunction
  • Ascites

Diastolic Dysfunction

Involves impaired ventricular filling. The ejection fraction will remain close to normal with this condition.

Causes Include:

• Valvular Disease
• Prolonged Hypertension
• Hypertrophic Cardiomyopathy

Common features include breathlessness on exertion and when lying flat, fatigue, reduced exercise tolerance, and fluid retention causing swelling of the legs and ankles. Pulmonary congestion may produce a persistent cough or wheeze.

Diagnosis is supported by clinical signs together with echocardiography to assess ejection fraction and ventricular function. Natriuretic peptides (BNP or NT-proBNP), chest X-ray, and electrocardiography are commonly used to confirm the diagnosis and identify the underlying cause.

• Sudden cardiac death
• Hypertension
• Fatty liver disease
• Diabetes
• Hypercholesterolemia
• hypertriglyceridemia