a significant problem in this population, especially in the very elderly, because they can be quite sensitive to preload reduction.
The following are the joined AHA/ACC recommendations for the management of patients with HF and preserved systolic function:
Class I recommendations
Control of systolic and diastolic hypertension in accordance with published guidelines. (Level of Evidence: A)
Control of ventricular rate in patients with atrial fibrillation. (Level of Evidence: C)
Diuretics to control pulmonary congestion and peripheral edema. (Level of Evidence: C)
Class IIa recommendations
Coronary revascularization in patients with coronary artery disease in whom symptomatic or demonstrable myocardial ischemia is judged to have an adverse effect on diastolic function. (Level of Evidence: C)
Class IIb recommendations
Restoration of sinus rhythm in patients with atrial fibrillation. (Level of Evidence: C) Use of beta-adrenergic blocking agents, ACE inhibitors, angiotensin receptor blockers, or calcium antagonists in patients with controlled hypertension to minimize symptoms of HF. (Level of Evidence: C)
Digitalis to minimize symptoms of HF. (Level of Evidence: C)
ACUTE DECOMPENSATION IN HF
Acute systolic or diastolic dysfunction, frequently due to acute coronary occlusion, results in a rapid rise in left ventricular filling pressures, and hence pulmonary capillary wedge pressure (PCWP), may rise rapidly after acute coronary occlusion. The rise in PCWP leads to rapid redistribution of fluid from the intravascular space into the extravascular space (lung interstitium and alveoli), with subsequent pulmonary edema, which represents a medical emergency.