DIASTOLIC DYSFUNCTION

2.  Diastolic Dysfunction with h/o Diastolic HF
        -He has preserved LV systolic function with evidence of diastolic
    dysfunction
  -Etiology:  Hypertensive Heart disease vs HCM?
    -It is important to avoid the common triggers of diastolic HF
    exacerbations such as tachycardia, afib, ischemia, and HTN
                -Would recommend a rhythm control approach, as patients with
                diastolic dysfunction can be more sensitive to loss of atrial
                kick
        -Would be careful so as to avoid excessive preload reduction in
        diastolic dysfunction
        -Will add beta-blocker
        -Upon subsequent visits, can consider eventual addition of an ARB, as
        there have been some evidence that ARBs may help with LV regression
        -Can also consider cardiac rehab in future for diastolic dysfunction

        -Thus, it is important to avoid triggers that could cause him to go
        into diastolic HF.  These triggers include:
                (a) Atrial Fibrillation
                        -There is a high association between patients with
                        diastolic dysfunction and Afib
                (b) Ischemia
                (c) HTN
        -It is also important to be careful to avoid excessive preload
        reduction in diastolic dysfunction, as diastolic dysfunction
        patients can be very sensitive to reductions in preload
    -Can consider Cardiac Rehabilitation
                -Exercise Training is the only intervention shown to improve
                exercise capacity and quality of life in patients with
                diastlic HF