Can elevated JVP and edema legs occur in isolated diastolic heart failure ?
Posted Apr 10 2010 11:22am
It is over a century old dictum , that edema legs and elevated JVP is the hallmark of cardiac failure.In fact , these two constitute major criteria of Framingham cardiac failure score.When these criterias were formulated the concept of diastolic heart failure was not in vogue. So we do not know whether the same would apply for diastolic heart failure also.
In all probability these conventional criteria may not apply to diastolic heart failure .
But why not ?
We know diastolic heart failure of the left ventricle is less likely raise the systemic venous pressure to cause the edema and raised JVP. But still , isolated LV diastolic dysfunction can increase the PCWP and PAP and RVP . Remember diastolic septal dysfunction , may compromise RV relaxation also.(Reverend Bernheim like effect)
We should also realise , raised venous pressure is not the only mechanism for edema legs.
Diastolic dysfunction can trigger ACE genes .IT can get activated and hence renal conservation of sodium.This neurohormonal activation can be dominant mechanism of edema in few. This prevails over the hydrostatic forces. And hence edema can result in isolated diastolic dysfunction.
What about RV diastolic dysfunction as a cause for right sided failure ?
This is a poorly understood entity.Logic suggests it may have clinical significance. Since morphologically and developmentally LV and RV share a common sheet of muscle , LV diastolic dysfunction can have it’s impact t on the RV as well.
Edema legs and raised JVP is a hall-mark of isolated systolic heart failure or combined systolic and diastolic failure .It is not rare to find an occasional patient isolated diastolic dysfunction* to present symptoms of systemic congestion .
*Of course , in this era of hi tech cardiology practice it may be inappropriate to depend on these primitive clincal criterias to diagnose CHF . (These manifest very late in the course of CHF!)