Systolic and diastolic heart failure

Sample Solution

Systolic vs. Diastolic Heart Failure: Understanding the Pump

Heart failure occurs when the heart weakens and struggles to pump blood effectively. There are two main types, differentiated by the specific weakness:

• Systolic Heart Failure: The heart muscle itself becomes weak and struggles to contract forcefully with each beat. This reduces the amount of blood pumped out of the heart with each contraction, leading to decreased blood flow throughout the body.
• Diastolic Heart Failure: The heart muscle stiffens and loses its ability to relax fully between beats. This impairs the heart's ability to fill properly with blood during the resting phase, resulting in decreased blood flow despite potentially normal contractions.

Patient Diagnosis: Unfortunately, I cannot diagnose a patient based on the provided information. However, I can explain the pathophysiology behind the listed symptoms to help you differentiate between systolic and diastolic heart failure.

Symptoms and Underlying Causes:

• Dyspnea on Exertion (Shortness of Breath):
  • Systolic Heart Failure: As exercise demands more blood flow, a weakened heart in systolic failure struggles to meet the increased need. This leads to fluid backup in the lungs, causing shortness of breath.
  • Diastolic Heart Failure: Similar to systolic failure, exercise can lead to shortness of breath due to the heart's inability to fill properly and meet the increased demand. However, it may occur at lower exertion levels compared to systolic failure.

Full Answer Section

• Pitting Edema (Swelling in Ankles and Feet):
  • Systolic Heart Failure: Fluid backs up in the circulatory system due to the heart's impaired pumping. This excess fluid leaks out of the capillaries into the surrounding tissues, causing swelling, particularly in the legs and feet due to gravity.
  • Diastolic Heart Failure: Similar to systolic failure, fluid buildup can occur due to impaired blood flow. However, it might be more prominent in the abdomen initially due to increased pressure in the veins draining the abdominal organs.
• Jugular Vein Distention (Swollen Neck Veins):
  • Systolic Heart Failure: Fluid backs up in the circulatory system due to the heart's inability to pump efficiently. This increased pressure is reflected in the jugular veins in the neck, which become swollen.
  • Diastolic Heart Failure: Similar to systolic failure, the stiffened heart can lead to jugular vein distention due to increased pressure. However, in some cases, it might be less prominent compared to systolic heart failure.
• Orthopnea (Shortness of Breath When Lying Down):
  • Systolic Heart Failure: Lying down allows fluid to redistribute in the body, causing more fluid to accumulate in the lungs. This worsens shortness of breath, especially when lying flat.
  • Diastolic Heart Failure: Similar to systolic failure, fluid redistribution can worsen shortness of breath when lying down. However, it might be more severe due to the heart's already compromised ability to fill with blood.

Third Heart Sound (S3) and Ejection Fraction (EF):

• Third Heart Sound: A normal heartbeat has two sounds. A faint additional sound (S3) can sometimes be heard in some heart conditions, including diastolic heart failure. It's caused by turbulent blood flow due to rapid filling of a stiff ventricle.
• Ejection Fraction (EF): This is a measure of the percentage of blood ejected from the left ventricle with each contraction. A normal EF is typically considered above 50%. An EF of 25% signifies a significantly weakened heart, which is more indicative of systolic heart failure.

Significance of Findings:

• A low EF (25%) strongly suggests systolic heart failure, as it indicates the heart's impaired pumping ability.
• The presence of an S3 sound can be a clue for diastolic heart failure, but it's not definitive and can be present in other conditions as well.

Remember, this information provides a general understanding but cannot replace a proper medical evaluation. If you are experiencing any of these symptoms, it's crucial to consult a healthcare professional for diagnosis and treatment.