Systolic versus diastolic dysfunction

Heart failure may be caused by:

• ventricular systolic dysfunction
• ventricular diastolic dysfunction

Systolic dysfunction:

• results in low blood pressures
• is most common
• caused by inadequate contractile capacity

Diastolic dysfunction:

• results in congestion
• caused by inability of the ventricle to relax correctly
• caused by myocardial or pericardial disease

Heart failure may be caused by mixed systolic and diastolic dysfunction. For example in a patient with hypertension and ischaemic heart disease there may be:

• a systolic dysfunction because of previous myocardial infarction
• a diastolic dysfunction because of scarring and myocardial hypertrophy