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http://www.aafp.org/afp/2004/0601/p2609.html
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Agora que deu a louca na Diástole, comecei a sentir saudade dos tempos do fluxo mitral.
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Como bem lembrado pelo Fabio Soares, onde foi parar a onda E?
Leiam o texto e vejam como era mais fácil em 2004.
Estavam errados? Pois a fisiopatologia não mudou.
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AGING
Diastolic dysfunction is more common in elderly persons, partly because of increased collagen cross-linking, increased smooth muscle content, and loss of elastic fibers.13,14 These changes tend to decrease ventricular compliance, making patients with diastolic dysfunction more susceptible to the adverse effects of hypertension, tachycardia, and atrial fibrillation.
HEART RATE
The heart rate determines the time that is available for diastolic filling, coronary perfusion, and ventricular relaxation. Tachycardia adversely affects diastolic function by several mechanisms: it decreases left ventricular filling and coronary perfusion times, increases myocardial oxygen consumption, and causes incomplete relaxation because the stiff heart cannot increase its velocity of relaxation as heart rate increases. Patients with diastolic dysfunction do not tolerate tachycardia or exercise well.
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VENTRICULAR LOAD
At the end of normal systole, a small residual volume of blood remains in the left ventricle. If this residual volume increases, it interferes with the normal elastic recoil of the heart, the relaxation of the heart, and the development of a negative pressure gradient between the ventricle and atria. As a result, rapid early diastolic filling is impaired.
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