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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Modern Heart Failure Labels
- Terminology shifted from "systolic vs diastolic" to HF-REF and HF-PEF in recent years.
- The labels reflect reduced versus preserved ejection fraction and guide diagnosis and management.
Different Diseases, Different Risks
- HF-REF and HF-PEF arise from different diseases and have distinct presentations and outcomes.
- Treating them the same increases risk and overlooks differing pathophysiology.
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.