4.8 Article

Diastolic heart failure

Journal

NEW ENGLAND JOURNAL OF MEDICINE
Volume 351, Issue 11, Pages 1097-1105

Publisher

MASSACHUSETTS MEDICAL SOC
DOI: 10.1056/NEJMcp022709

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A 78-year-old woman with a history of hypertension is admitted to the hospital with congestive heart failure. Physical examination reveals a blood pressure of 180/90 mm Hg, increased jugular venous pressure, peripheral edema, and pulmonary rales. A chest radiograph shows pulmonary edema and mild cardiomegaly. An echocardiogram (Fig. 1) shows increased thickness of the left ventricular wall, a left ventricular cavity of normal size, left atrial enlargement, and a left ventricular ejection fraction of 70 percent. The left ventricular Doppler filling pattern is abnormal and consistent with an elevated pulmonary-capillary wedge pressure. How should this patient be treated?

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