Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 52: Diastolic Heart Failure with Todd Dorman
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Aug 7, 2017 In this discussion, Dr. Todd Dorman, a leading expert in critical care from Johns Hopkins, dives deep into diastolic heart failure. He explains the significance of distinguishing between heart failure with preserved ejection fraction (HF-PEF) and reduced ejection fraction (HF-REF). Topics include the clinical implications of ejection fraction changes and the importance of accurate diagnosis through emerging echocardiographic techniques. Dorman also shares management insights, emphasizing heart rate, preload, and afterload tailored to each type of heart failure.
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EF Often Reflects Chamber Size
- EF is a ratio of stroke volume over end-diastolic volume, so changes often reflect denominator shifts.
- A low EF commonly means a dilated ventricle rather than directly indicating poor stroke volume in compensation.
Echo Before Assumptions
- Use echocardiography to distinguish dilated ventricles from hypertrophy and to assess diastolic indices like E/E'.
- When EF is high, manage patients as if they may have diastolic dysfunction until proven otherwise.
How Diastolic Filling Changes
- Diastolic dysfunction shifts filling from passive (E) to atrial contraction (A), producing E/A reversal on Doppler.
- Early relaxation problems progress to stiff, non-compliant ventricles with worsening patterns.