Congestive heart failure may be considered a condition in which cardiac output is not adequate to meet the metabolic needs of the body, either at rest or with exercise, usually accompanied by an increase in cardiac filling pressure and / or volume.
Implicit in that physiological definition is that heart failure can be caused by an abnormality in systolic function leading to a defect in expulsion of the blood ( systolic heart failure ), or by an abnormality in diastolic function leading to a defect in ventricular filling ( diastolic heart failure ).
The former is the more familiar, classic heart failure in which an impaired inotropic state is responsible. Less familiar, but perhaps just as important, is diastolic heart failure, in which the ability of the ventricle(s) to accept blood is impaired. This problem is not rare, accounting in some series for as many as one third of patients presenting with heart failure.
Although the clinical manifestations of heart failure with and without systolic dysfunction are frequently very similar, the pathophysiological processes underlying the syndromes and consequently the treatment are quite different.
This article discusses pathophysiological, clinical, diagnostic and therapeutic aspects of this form of heart failure.
