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Care and Management of the Patient with Right Heart Failure Secondary to Diastolic Dysfunction: An Advanced Practice Perspective and Case Review

Until recently, most clinical trials associated with heart failure have studied systolic dysfunction. With the escalating geriatric population and dramatic increases in costs related to cardiovascular management regimens, more attention is being given to understanding diastolic failure induced by uncontrolled hypertension and cardiomyopathies. Researchers have demonstrated that the compensatory mechanisms associated with left ventricular diastolic dysfunction lead to elevated right heart pressures and eventually to right heart failure. When congestive heart failure is diagnosed, studies should be accomplished to differentiate between ventricular systolic or ventricular diastolic origins of the disease process, both to understand the origins of the heart failure and to guide clinical management. Therapy regimens and treatment goals must be directed toward controlling both systolic and diastolic pressures in order to achieve optimum outcomes.