About Diastolic Heart Failure

Overview

Diastolic heart failure refers to a condition where the left ventricle of the heart has difficulty relaxing during the diastole phase, which is the period between heartbeats. This leads to inadequate filling of the ventricle with blood, resulting in a reduced amount of blood being pumped out to the body with each heartbeat. Diastolic heart failure is also known as heart failure with preserved ejection fraction (HFpEF). It is characterized by clinical signs and symptoms of heart failure, such as shortness of breath and fatigue, but with normal diastolic volume and predominantly abnormalities in relaxation and increased passive stiffness. Diastolic heart failure is often seen in patients with a history of hypertension or infiltrative cardiac diseases. Diagnosis is typically made through echocardiography, which evaluates the function and structure of the heart. Treatment options for diastolic heart failure focus on managing symptoms and addressing underlying conditions that contribute to the condition.

Causes and Risk Factors

The causes of diastolic heart failure are not fully understood, but several mechanisms may contribute to the disease. These include:

• Problems with the function of the cells that line blood vessels.
• Changes in how the cells of the heart process glucose and fatty acids.
• Buildup of fibrous tissue in the heart.
• Increase in oxidative stress.

The non-modifiable risk factors for diastolic heart failure are factors that cannot be changed. These include:

• Advancing age
• Family history of heart failure

The modifiable risk factors for diastolic heart failure are factors that can be influenced or changed. These include:

• Hypertension (high blood pressure)
• Diabetes mellitus (high blood sugar)
• Obesity
• Sedentary lifestyle (lack of regular exercise)
• Smoking
• High cholesterol levels
• Excessive alcohol consumption

It's important to note that while these modifiable risk factors can be addressed, it's always best to consult with a healthcare professional for personalized advice. They can provide guidance on lifestyle modifications and appropriate medical interventions.

Symptoms

In the early stages of diastolic heart failure, you may not notice any symptoms. However, as the condition progresses or becomes more severe, the following symptoms may occur:

• Shortness of breath
• Difficulty exercising
• Fatigue and weakness
• Swelling and weight gain
• Dry cough
• Unexplained weight gain
• Trouble sleeping or waking up at night short of breath
• Loss of appetite or nausea
• Heart palpitations
• Wheezing or coughing, possibly with white or blood-tinged phlegm
• Fluid retention leading to swelling in the lower legs or abdomen (edema)
• Nausea
• Racing heart rate or irregular heartbeat (heart palpitations)
• Fatigue

It's important to note that these symptoms can vary in severity. If you experience any recurrent or persistent symptoms, it's advisable to seek medical attention. A healthcare professional can assess your symptoms and provide appropriate guidance and treatment.

Diagnosis

To diagnose diastolic heart failure, doctors commonly perform the following examinations, tests, and procedures:

• Blood tests: These tests measure molecules that increase during heart failure, such as B-type natriuretic peptide (BNP). They can also assess liver and kidney function.
• Echocardiography: An echocardiogram helps measure a person's ejection fraction, which is an indicator of how well the heart is pumping blood.
• Other imaging tests: Additional imaging tests like computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and nuclear heart scans may be ordered to evaluate the structure and function of the heart.
• Electrical tests: Tests of electrical functions, such as an electrocardiogram (EKG), Holter or event monitor, or stress test, can assess the heart's response to stress and its effect on blood flow.

To determine the stage or severity of diastolic heart failure, additional examinations, tests, and procedures may include:

• Repeat echocardiography: This can help monitor changes in the heart's structure and function over time.
• Cardiac catheterization: This procedure involves inserting a thin tube into a blood vessel to measure pressures in the heart chambers and assess blood flow.

Remember to consult with your healthcare professional for personalized advice on which examinations, tests, and procedures are appropriate for your individual situation.

Treatment Options

The goals of treatment for diastolic heart failure are to relieve symptoms, prevent hospitalization and improving the quality of life. Treatment for diastolic heart failure can include various types of treatment. These include:

Medications:

• ACE inhibitors or ARBs: These medications help relax blood vessels and reduce blood pressure.
• Diuretics: They help remove excess fluid from the body, reducing swelling and shortness of breath.
• Beta-blockers: These medications can slow the heart rate and improve heart function.
• Calcium channel blockers: They relax blood vessels and reduce the workload on the heart.
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors: Recent studies have shown that these medications reduce the risk of cardiovascular death and hospitalization for people with diastolic heart failure.
• Spironolactone: When added to other blood pressure-lowering drugs, it has been found to improve outcomes for people with diastolic heart failure and resistant hypertension.

Therapies and procedures:

• Cardiac rehabilitation program: This program helps individuals with heart failure exercise safely under supervision, improving cardiovascular fitness.

Health behavior changes:

• Following a heart-healthy diet low in sodium, saturated fats, and cholesterol
• Engaging in regular physical activity as recommended by a healthcare professional
• Limiting alcohol consumption
• Quitting smoking

It's important to note that these recommendations are general in nature. The specific treatment plan should be discussed with a healthcare professional who can tailor it to individual needs. Medication dosing may be affected by many factors. Check with your healthcare professional about dosing for your individual situation. Other side effects can occur. Check with your healthcare professional or read the information provided with your medication for additional side effect information.