医学
舒张期
心脏病学
内科学
背景(考古学)
血压
生物
古生物学
作者
Filippo Sanfilippo,Elena Bignami,Marinella Astuto,Antonio Messina,Gianmaria Cammarota,Salvatore Maurizio Maggiore,Luigi Vetrugno
出处
期刊:Minerva Anestesiologica
[Edizioni Minerva Medica]
日期:2022-11-01
卷期号:88 (11)
被引量:10
标识
DOI:10.23736/s0375-9393.22.16425-4
摘要
Left ventricular (LV) diastolic dysfunction is a commonly encountered condition and its impact on the anesthesia and the intensive care population is often underestimated. The study of the diastole is known as “diastology” and comprises four phases: isovolumetric relaxation, early filling phase, diastasis, and late filling phase. Diastolic function needs at least the same attention as systolic function, since its alteration has been associated with worse prognosis. Notwithstanding, many physicians consider the assessment of diastolic function too much complex. In this context, the latest 2016 guideline have simplified the assessment of diastolic function. In this educational review, we approach diastolic dysfunction with didactic purposes. First, we use a metaphor to consider the LV as a glass that progressively changes its shape and height along the disease course, resembling variable end-diastolic pressures and volumes at different stages while progressing with diastolic dysfunction. We guide readers in the process of diagnosis and grading of LV diastolic dysfunction, with description of pathophysiological changes in LV relaxation and consequently in the pressure gradient between the left-sided heart chambers. In the second part, starting from physiology we move towards suggestions for the clinical management of anesthesia and intensive care patients with diastolic dysfunction under different scenarios (hypo- and hypervolemia, weaning, sepsis, tachycardia and arrhythmias, right ventricular dysfunction).
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