Introduction to Diastolic Dysfunction and Heart Failure

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Diastolic dysfunction is a heart condition caused by "stiffness" in the heart's ventricles ( the main pumping chambers ). This relative stiffness limits the heart's ability to fill with blood between beats.

What are diastolic dysfunction and diastolic heart failure?

The cardiac cycle is divided into two parts: systole and diastole. During systole, the ventricles contract and pump blood from the heart to the arteries. Once the ventricles stop contracting, they relax and, during this relaxation, fill with blood to prepare for the next systole. This relaxation phase of the cardiac cycle is called diastole .

Sometimes, as a result of various diseases, the ventricles begin to become relatively "stiff." Rigid ventricles cannot fully relax during diastole; as a result, the ventricles may not fill completely. As a result of this incomplete filling of the ventricles, the amount of blood pumped, followed by the contraction of the heart, will be slightly reduced. Also, blood returning to the heart can become partially blocked in the body's organs, including the lungs. However, leg swelling is even more common.

The abnormal thickening of the ventricles and the resulting abnormal filling of the ventricles during diastole is called diastolic dysfunction .

Diastolic dysfunction is very mild at first and usually does not cause symptoms. However, diastolic dysfunction progresses over time. When the condition becomes severe enough to cause lung congestion or leg swelling, diastolic heart failure is said to be present.

In general, when doctors use the terms diastolic dysfunction and diastolic heart failure, they are referring to isolated diastolic disorders: diastolic dysfunction without signs of systolic dysfunction. ("Systolic dysfunction" is just another name for the weakening of the heart muscle that occurs in more common forms of heart failure .)

In recent years, some cardiologists have started calling diastolic heart failure "heart failure with preserved ejection fraction" or "HFpEF."

Who suffers from diastolic dysfunction?

Diastolic dysfunction and diastolic heart failure are relatively new cardiac diagnoses. Of course, they always have been, but only in the last three decades or so, since echocardiography has been widely used to diagnose heart problems, these conditions have become generally accepted.

The diagnosis of diastolic dysfunction is now quite common, especially in people over the age of 45, most of whom are surprised to learn that they have a heart problem. While some of these people will develop true diastolic heart failure, many will not, especially if they receive proper medical attention and take care of themselves.

Also, diastolic heart failure is often diagnosed today. Diastolic heart failure is found in almost half of patients who present to the emergency department with episodes of acute heart failure.

People with diastolic dysfunction and diastolic heart failure may be older (over 45 years old), overweight or obese, have high blood pressure, be female, and have no history of heart attacks. It is currently believed that the risk of developing diastolic dysfunction in men and women is the same, but that older men who are obese and hypertensive are more likely to have heart attacks than women of the same age, making it more likely that have heart problems. failure. be "standard" congestive heart failure than diastolic heart failure .

What Causes Diastolic Dysfunction?

Certain conditions appear to contribute to diastolic hardness of the heart. This includes:

Symptoms

People with diastolic dysfunction generally have no obvious symptoms of this condition. However, they may notice a gradual decrease in exercise capacity (which they probably associate with age and being overweight).

When diastolic heart failure occurs, the main symptom is shortness of breath (shortness of breath), as is the case with congestive heart failure. However, unlike congestive heart failure (whose symptoms usually develop gradually over several hours or days), shortness of breath with diastolic heart failure is likely to be sudden at first and very severe right away. These episodes are commonly called " sudden pulmonary edema."

Diagnostics

Diastolic dysfunction and heart failure are diagnosed by echocardiography .

In people with diastolic dysfunction, the echocardiogram evaluates the characteristics of diastolic relaxation; in other words, for "stiffness".

In people with diastolic heart failure, an echocardiogram shows diastolic stiffness along with normal systolic (pumping) heart function. In particular, the left ventricular ejection fraction is normal in a person with heart failure. In fact, most cardiologists today prefer the term preserved heart failure or HFpEF to the older term diastolic heart failure.

Learn more about the symptoms and diagnosis of diastolic heart failure and diastolic dysfunction .

Watch out

Treatment of diastolic dysfunction aims to reduce its underlying causes. Losing weight, exercising a lot, treating high blood pressure, controlling diabetes, and reducing risk factors for coronary heart disease can improve the diastolic function of the heart.

Treating diastolic heart failure can be problematic because many of the drugs that are effective in treating congestive heart failure have little or no benefit. In acute lung edema, diuretics (eg Lasix) are the mainstay of treatment. As with anyone with diastolic dysfunction, lifestyle changes and aggressive treatment of high blood pressure and diabetes help prevent recurring episodes of heart failure. If atrial fibrillation has occurred, it is important to take steps to prevent recurrence of this arrhythmia, as it can cause cardiac decompensation in people with diastolic heart failure .

Learn more about treating diastolic dysfunction and diastolic heart failure .

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