Cardiovasculaire Geneeskunde.nl

Diastolisch hartfalen: risico’s en behandeling

Slides (presentatie) - Oct. 13, 2011

Diastolisch hartfalen: risico’s en behandeling
 


Drs. Loek van Heerebeek – cardioloog i.o
Vrije Universiteit medisch centrum, Amsterdam


Bekijk de presentatie

Klik voor het bekijken van de presentatie op onderstaande afbeeldingen

 


Prevalence of DHF

Mortality in SHF and DHF

DHF??

Eur Heart J 2011;32:670

2009 update of ACC/AHA 2005 guidelines on HF

Distinct remodeling in DHF vs SHF

Distinct myocardial structural characteristics in DHF vs SHF

Eur Heart J 2007;28:2539

Invasive diagnosis of DHF

Invasive diagnosis of DHF

DHF: any change in pre- or afterload induces larger shifts in BP

JACC 2009;54:410; JACC Img 2008;1:366

DHF:  systolic (l,r) strain, apical rotation;  and delayed untwisting

DHF: exertional dyspnea with exercise tolerance

Circulation 2006;114:2138; Eur Heart J 2011;32:670

RISK FACTORS

Risk factors for diastolic dysfunction

JACC 2006;47:76; JACC 2007;50:768

Risk factors for diastolic dysfunction

Risk factors for diastolic dysfunction

Risk factors for diastolic dysfunction

Risk factors for diastolic dysfunction

MONICA Augsburg

Risk factors for diastolic dysfunction

Risk factors for diastolic dysfunction

Metabolic syndrome - Definitions

Risk factors for diastolic dysfunction

DHF pathophysiology

Extracellular matrix and cardiomyocytes determine myocardial

Disturbances in cardiomyocyte Ca2+ handling can impair relaxation

Impaired myocardial energetics in DHF

Extracellular matrix and cardiomyocytes determine myocardial

Increased interstitial fibrosis in hypertensive heart disease

CVF

ACE-I /ARBs

Discordant treatment outcome in SHF vs DHF





Biophys J 2007;93:1719

Biophys J 2007;93:1719

Stiff “spring”

Titin regulates cardiomyocyte intrinsic stiffness



Antiox & Redox Signal 2008;10:1115

Van Heerebeek et al, Circulation 2008;117:43

DHF treatment options

Roadmap for treatment of DHF

Spironolactone in DHF

PDE5-I; ISDN-Hydralaz;

Nesiritide in acute HF

PDE5-inhibition with sildenafil in SHF

Statins;PDE5-I

Statins in DHF

Deze inhoud is bedoeld voor medische professionals. Om dit te bekijken is registratie noodzakelijk. Registreer gratis voor onbeperkte toegang tot ons educatief materiaal.

Deel deze pagina met collega's en vrienden: