An Overview of Heart Failure & Valvular Heart Disease

October 27, 2018

By Erika Nigam, PA-C
AASPA President

Heart Failure is a common disease process that currently affects approximately 5.1 million people in the United States alone. This is a condition that can affect both children and adults, however the symptoms will differ among the age groups. There is no cure for heart failure, however with medical treatment and lifestyle changes, this condition can be managed to allow individuals to continue living a normal life. Treatment goals are aimed at reducing a morbidity and mortality.

Heart failure is defined as the inability of the heart to pump enough blood to rest of the body in order to meet the body's metabolic demands. Heart failure is divided into two classifications. In short, the problem is either a pump problem or a filling problem, in that the heart fails to pump out enough blood to the rest of the body (cardiac output) or the heart is incapable of filling with enough blood to pump out to the rest of the body (cardiac input). The inability of the heart to pump enough blood to the rest of the body is defined as Systolic Heart Failure. The inability to fill the heart (ventricle) with enough blood to meet the metabolic demands of the body is called Diastolic Heart Failure. It should be noted that systolic and diastolic heart failure are two distinct and different diagnoses.

The left ventricular ejection fraction (LVEF), which can also be looked as the cardiac output, is what defines and differentiates these two diagnoses. A normal LVEF is defined as greater than 50% in most cases, a normal LVEF is 55-70%. LVEF is a direct measurement of the contractility of the left ventricle with every beat. In systolic heart failure the LVEF is reduced, typically defined as less than 35-40%, and progressive chamber dilatation. Diastolic heart failure is often termed "heart failure with a preserved ejection fraction." The LVEF in diastolic heart failure is often greater than 50% however depending on the practice this definition may include a range that is greater than 35-40% or higher. It is important to differentiate between those who have normal LVEF (>50%) and those who have near normal LVEF (35/40-50%) Diastolic dysfunction is due to and defined by the amount of left ventricular hypertrophy and concentric remodeling.

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