RE: [EXTERNAL] RE: end stage CHF
Would not some type of diastolic dysfunction need to be demonstrated in order to make the argument for Diastolic CHF?
Diastolic Dysfunction: A newly recognized condition that can influence ventricular performance and may lead to pulmonary venous congestion without significant declines in ventricular systolic performance. The impediment to diastolic filling results from fibrosis and scarring (or infiltration) of the ventricle. May be seen with various forms of myocardial hypertrophy or ischemia due to CAD. Diastolic heart failure occurs when the heart has a problem relaxing between contractions (diastole) to allow enough blood to enter the ventricles. The heart cannot fill with sufficient blood because the heart muscle is stiff and unable to relax. This may lead to fluid accumulation, especially in the legs, ankles and feet. Some patients may also have lung congestion. The treatment depends on the underlying cause. Beta blockers and calcium channel blockers are often used when diastolic dysfunction is due to ischemia or hypertension
This type of ventricular failure is related to impaired ventricular filling caused by hypertrophied (less compliant) ventricles or by impaired ventricular relaxation. Hypertrophy can result from chronic hypertension or aortic valve stenosis. Some patients may have a genetic defect that causes hypertrophic cardiomyopathy (HCM). Diastolic dysfunction can also occur due to a stiffening of the ventricular wall (restrictive cardiomyopathy) caused by fibrosis. These patients will often have normal or near normal ejection fractions. Diastolic dysfunction results in large increases in ventricular end-diastolic pressure, which can lead to pulmonary edema. Despite a large end-diastolic pressure, the end-diastolic volume may actually be reduced because of the decreased ventricular compliance
Source: http://cvpharmacology.com/clinical topics/heart failure-3.htm
We have some Cardiologists today that do not (unfortunately) agree that all patients with known heart failure can be clearly classified as either systolic or diastolic…so, I am not sure I understand the statement that ‘at a minimum everyone has diastolic CHF”. This remains controversial with our staff as some in Cardio feel the classification of systolic or diastolic can be made for all patients with CHF, while others disagree with that concept.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org
Diastolic Dysfunction: A newly recognized condition that can influence ventricular performance and may lead to pulmonary venous congestion without significant declines in ventricular systolic performance. The impediment to diastolic filling results from fibrosis and scarring (or infiltration) of the ventricle. May be seen with various forms of myocardial hypertrophy or ischemia due to CAD. Diastolic heart failure occurs when the heart has a problem relaxing between contractions (diastole) to allow enough blood to enter the ventricles. The heart cannot fill with sufficient blood because the heart muscle is stiff and unable to relax. This may lead to fluid accumulation, especially in the legs, ankles and feet. Some patients may also have lung congestion. The treatment depends on the underlying cause. Beta blockers and calcium channel blockers are often used when diastolic dysfunction is due to ischemia or hypertension
This type of ventricular failure is related to impaired ventricular filling caused by hypertrophied (less compliant) ventricles or by impaired ventricular relaxation. Hypertrophy can result from chronic hypertension or aortic valve stenosis. Some patients may have a genetic defect that causes hypertrophic cardiomyopathy (HCM). Diastolic dysfunction can also occur due to a stiffening of the ventricular wall (restrictive cardiomyopathy) caused by fibrosis. These patients will often have normal or near normal ejection fractions. Diastolic dysfunction results in large increases in ventricular end-diastolic pressure, which can lead to pulmonary edema. Despite a large end-diastolic pressure, the end-diastolic volume may actually be reduced because of the decreased ventricular compliance
Source: http://cvpharmacology.com/clinical topics/heart failure-3.htm
We have some Cardiologists today that do not (unfortunately) agree that all patients with known heart failure can be clearly classified as either systolic or diastolic…so, I am not sure I understand the statement that ‘at a minimum everyone has diastolic CHF”. This remains controversial with our staff as some in Cardio feel the classification of systolic or diastolic can be made for all patients with CHF, while others disagree with that concept.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org