Monday, April 15, 2019

Diastolic Heart Failure Vs. Ejection Fraction Failure and How to Correctly Diagnose

Figure 1. This image of a heart relates to the topic of the literature review, heart failure. In the image, one can see the area where blood enters (the blue) and where blood exists (the red). Moderator, N. (2006). PurposeGames [Online image]. Retrieved April 13, (2019), from: https://www.purposegames.com/game/the-heart-quiz

The human heart is one of the most important and beautiful organs in the human body. While being the size of an individual’s fully-grown fist, the human heart is engineered to perfection with one task and one task only… to pump oxygen-rich blood to the rest of the body. This masterpiece, however, is not invincible. Depending on one’s genetics, eating habits or age, the heart could develop a defect. Heart disease/failure is the “Leading cause of death” in the United States (CDC Data for the U.S). The most common diagnosis for heart disease/failure is “Coronary heart disease” according to the NHS (National Health Service). However, there are many different categories in the field of heart diseases such as Congenital heart disease, arrhythmia heart disease, diastolic heart failure, and ejection fraction heart failure. For this review, we will focus on two specific illnesses: diastolic heart failure, and ejection fraction heart failure. 
The beating vessel in our chest is made up of four main components: the right atrium and the right ventricle followed by the left atrium and left ventricle. The right atrium is responsible for pumping deoxygenated blood into the right ventricle of the heart. This section of the heart (the right ventricle) pumps blood through your pulmonary veins which leads to your lungs, supplying fresh oxygen to your blood. From there, the blood flows through your pulmonary arteries and into your left ventricle, and from there it flows into the left atrium and into your aorta, supplying the oxygenated blood back into your body. However, for this review, we will be focusing on two main components of the heart, the right, and the left ventricle. When an individual faces diastolic heart failure, one or both of their ventricles become stiff or harder than they need to be, restricting the amount of deoxygenated and oxygenated blood to be pumped to the heart or body. Therefore, an individual may experience symptoms that include shortness of breath, constant fatigue, swelling of ankles, legs, feet, etc. Your ventricular heart muscles thicken because your heart is working twice or three times as hard to pump blood to the left atrium and to the aorta.
In the event of ejection fraction failure, it is only the left ventricle that dilates and struggles to relax when receiving oxygenated blood. Ejection fraction failure is dangerous because it is your left ventricle that is responsible for pumping oxygenated blood to the rest of the body, if it cannot do that then you are starving your muscles and other important organs of oxygen-rich blood, causing them to fail and eventually shut down.
In order to diagnose someone correctly with diastolic heart failure, one must follow three main criterions. “(1) show symptoms and signs consistent with heart failure (including dyspnea); (2) have a nondilated left ventricle with preserved ejection fraction ≥50%; and (3) display evidence of structural heart disease, such as evidence of diastolic dysfunction on echocardiography.” (The American Journal of Medicine). Making sure that a patient shows obvious signs of dyspnea, which means difficulty breathing or shortness of breath, that they display a regular, nondilated left ventricle, meaning that their left ventricle is not working harder than it should when pumping blood and three; to show difficulty relaxing when heart chambers fill with blood (diastolic dysfunction). These are three important, life-changing steps that if followed correctly could properly diagnose someone with diastolic heart failure. The left ventricle and the blood percentage when filling the left ventricle is what determines whether or not an individual is facing ejection fraction heart failure or diastolic heart failure.
Now when diagnosing a patient with ejection fraction heart failure, a physician must look for similar symptoms of a patient with diastolic heart failure. They must show signs of fatigue, shortness of breath, etc. However, the main difference would be the dilation of one's left ventricle and the amount of blood being pumped out lower than 40%. The dilation of one's left ventricle tells us that there is very little relaxation taking place when the left ventricle relaxes to fill with blood; because of this, the ventricle will dilate (grow in size).
Both diastolic and ejection fraction failure have similar symptoms such as shortness of breath, chest pain, and constant fatigue just to name a few. With both ailments so similar, it is easy to blur the line between the two.  So, if a doctor were to passively look at reports, a misdiagnosis may occur, resulting in the use of unnecessary materials, costing the hospital and the patient money and possibly their life.  However, for every problem, there is a solution. If we were to follow and check the criteria list thoroughly, following the three basic rules when diagnosing someone with heart disease/failure, correct diagnosis rates would skyrocket, limiting the amount of misdiagnosis, which would in return, lower the rates of heart-related deaths. Furthermore, hospitals would save time and resources while saving the lives of people by applying a more effective treatment the first time, providing patients with a speedy recovery. The human heart is one of the most important and beautiful organs in the human body. While being the size of an individual’s fully-grown fist, the human heart is engineered to perfection with one task and one task only… to pump oxygen-rich blood to the rest of the body. This masterpiece, however, is not invincible. Depending on one’s genetics, eating habits or age, the heart could develop a defect. Heart disease/failure is the “Leading cause of death” in the United States (CDC Data for the U.S). The most common diagnosis for heart disease/failure is “Coronary heart disease” according to the NHS (National Health Service). However, there are many different categories in the field of heart diseases such as Congenital heart disease, arrhythmia heart disease, diastolic heart failure, and ejection fraction heart failure. For this review, we will focus on two specific illnesses: diastolic heart failure, and ejection fraction heart failure.  
The beating vessel in our chest is made up of four main components: the right atrium and the right ventricle followed by the left atrium and left ventricle. The right atrium is responsible for pumping deoxygenated blood into the right ventricle of the heart. This section of the heart (the right ventricle) pumps blood through your pulmonary veins which leads to your lungs, supplying fresh oxygen to your blood. From there, the blood flows through your pulmonary arteries and into your left ventricle, and from there it flows into the left atrium and into your aorta, supplying the oxygenated blood back into your body. However, for this review, we will be focusing on two main components of the heart, the right ventrical, and the left ventricle. When an individual faces diastolic heart failure, one or both of their ventricles become stiff or harder than they need to be, restricting the amount of deoxygenated and oxygenated blood to be pumped to the heart or body. Therefore, an individual may experience symptoms that include shortness of breath, constant fatigue, swelling of ankles, legs, feet, etc. Your ventricular heart muscles thicken because your heart is working twice or three times as hard to pump blood to the left atrium and to the aorta.
In the event of ejection fraction failure, it is only the left ventricle that dilates and struggles to relax when receiving oxygenated blood. Ejection fraction failure is dangerous because it is your left ventricle that is responsible for pumping oxygenated blood to the rest of the body if it cannot do that then you are starving your muscles and other important organs of oxygen-rich blood, causing them to fail and eventually shut down.
In order to diagnose someone correctly with diastolic heart failure, one must follow three main criterions. “(1) show symptoms and signs consistent with heart failure (including dyspnea); (2) have a nondilated left ventricle with preserved ejection fraction ≥50%; and (3) display evidence of structural heart disease, such as evidence of diastolic dysfunction on echocardiography.” (The American Journal of Medicine). Making sure that a patient shows obvious signs of dyspnea, which means difficulty breathing or shortness of breath, that they display a regular, nondilated left ventricle, meaning that their left ventricle is not working harder than it should when pumping blood and three; to show difficulty relaxing when heart chambers fill with blood (diastolic dysfunction). These are three important, life-changing steps that if followed correctly could properly diagnose someone with diastolic heart failure. The left ventricle and the blood percentage when filling the left ventricle is what determines whether or not an individual is facing ejection fraction heart failure or diastolic heart failure.
Now when diagnosing a patient with ejection fraction heart failure, a physician must look for similar symptoms of a patient with diastolic heart failure. They must show signs of fatigue, shortness of breath, etc. However, the main difference would be the dilation of one's left ventricle and the amount of blood being pumped out lower than 40%. The dilation of one's left ventricle tells us that there is very little relaxation taking place when the left ventricle relaxes to fill with blood; because of this, the ventricle will dilate (grow in size).
Both diastolic and ejection fraction failure have similar symptoms such as shortness of breath, chest pain, and constant fatigue just to name a few. With both ailments so similar, it is easy to blur the line between the two.  So, if a doctor were to passively look at reports, a misdiagnosis may occur, resulting in the use of unnecessary materials, costing the hospital and the patient money and possibly their life.  However, for every problem, there is a solution. If we were to follow and check the criteria list thoroughly, following the three basic rules when diagnosing someone with heart disease/failure, correct diagnosis rates would skyrocket, limiting the amount of misdiagnosis, which would in return, lower the rates of heart-related deaths. Furthermore, hospitals would save time and resources while saving the lives of people by applying a more effective treatment the first time, providing patients with a speedy recovery.

By: Joshua Modeste, University of Florida


References

  
CDC, NCHS. Underlying Cause of Death 1999-2013 on CDC WONDER Online
 Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed Feb. 3, 2015.Argulian, E., & Messerli, F. H. (n.d.). Misconceptions and Facts About “Diastolic” Heart Failure.


Argulian, E., & Messerli, F. H. (2014). Review: Misconceptions and Facts About ‘Diastolic’
 Heart Failure. The American Journal of Medicine, 127, 1144–1147. https://doi.org/10.1016/j.amjmed.2014.06.010

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