Pathophysiology : Systolic heart failure


  • Systolic heart failure
    • HFrEF – HF with reduced EF
    • Inability to pump blood forward
    • Caused by
      • Impaired contractile function
      • Increased afterload
      • Cardiomyopathy
      • Mechanical abnormalities
    • Decreased LV ejection fraction (EF)
  • Diastolic heart failure
    • HFpEF – HF with preserved EF
    • Impaired ability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume and CO
    • Result of left ventricular hypertrophy from hypertension, older age, female, diabetes, obesity
    • Same end result as systolic failure
  • Mixed heart failure
    • Mixed systolic and diastolic failure
      • Seen in disease states such as dilated cardiomyopathy (DCM)
      • Poor EFs (<35%)
      • High pulmonary pressures
      • Biventricular failure
        • Both ventricles may be dilated and have poor filling and emptying capacity
  • Right-sided heart failure
    • RV fails to pump effectively
    • Fluid backs up in venous system
    • Fluid moves into tissues and organs
    • Left-sided HF is most common cause
      • Other causes include RV infarction, PE, and cor pulmonale (RV dilation and hypertrophy)
  • Heart failure
    • Ventricular failure leads to:
      • Low blood pressure (BP)
      • Low CO
      • Poor renal perfusion
    • Abrupt or subtle onset
    • Compensatory mechanisms mobilized to maintain adequate CO.


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