Distinguish between systolic and diastolic heart failure.

• A. Systolic: reduced EF due to stiff ventricles; Diastolic: preserved EF due to poor contractility
• B. Systolic: reduced EF due to poor contractility; Diastolic: preserved EF but impaired filling due to stiff ventricles
• C. Systolic: preserved EF; Diastolic: reduced EF due to poor contractility
• D. Systolic: reduced EF due to dilated ventricles; Diastolic: preserved EF

Answer: (D)

Systolic heart failure shows a reduced ejection fraction because the heart’s pumping ability is weakened, often with the ventricle dilating and becoming less efficient at ejecting blood. Diastolic heart failure has a preserved ejection fraction because the contraction is still okay, but filling is impaired due to a stiff, noncompliant ventricle. So the statement that systolic failure has reduced EF (often with dilated ventricles) and diastolic failure has preserved EF (with impaired filling from stiffness) best captures the distinct mechanisms.