Follow this link for a great CMAJ review of the management of acute decompensated heart failure.
One thing that was touched on was the concept of congestive heart failure with preserved ejection fraction, aka "Diastolic Dysfunction" which occurs in 1/3 of patients with heart failure.
This type of dysfunction occurs as a result of concentric LV hypertrophy, and impaired ventricular relaxation as a result. As the ventricle does not sufficiently relax in diastole, filling (and thus forward flow) are impaired.
Risk factors include age, female gender, hypertension, coronary artery disease, diabetes mellitus, restrictive cardiomyopathy from infiltrative causes.
Diagnosis: Clinical evidence of heart failure with an ejection fraction greater than 50%. Echocardiogram can be helpful as it may show alterations in the E:A ventricular filling ratio (E is early, A is for atrial kick), as well as left atrial enlargement (more than 4cm), or evidence of hypertrophy (IV septum greater than 1cm, LV mass greater than 100gm/m2 body surface area).
Treatment: There is a lack of evidence when it comes to treating CHF with preserved EF. Guidelines (ACC/AHA) recommend controlling blood pressure, treating edema and controlling heart rate to allow greater LV filling time.
Follow this link for a NEJM review on the subject.
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