Advances in echocardiography identified a new yet old problem: diastolic dysfunction. Diastolic dysfunction may lead to diastolic heart failure and further complications.
Diastolic dysfunction and heart failure are most common in older women. Often, those women don’t realize they have any heart problems at all until they present themselves in an emergency room with some of the symptoms.
Some patients suffering from diastolic dysfunction eventually develop heart failure. Diastolic heart failure is a life-threatening condition that requires aggressive treatment and intervention.
What does that mean? We’ll guide you through diastolic dysfunction and diastolic heart failure to show you what it means for your health.
Diastolic Dysfunction: What Is It?
Your cardiovascular system is a cycle that includes two parts. One of those parts is the diastole. It is the lower number of your blood pressure reading.
During the diastolic phase, your heart relaxes after contracting to pump blood. As the ventricles relax, the blood enters to prepare for a new contraction or a new round of pumping blood.
Diastolic dysfunction occurs when your heart struggles to relax because the muscles that make up the ventricles become too stiff. Stiff ventricles that fail to relax also struggle to fill up with blood.
Your heart’s pumping system is exact. It pumps a percentage of blood, known as an ejection fraction, with every beat. A healthy heart pumps just over half of its value on each beat, which means your heart’s normal ejection fraction is greater than 50 percent.
When you have diastolic dysfunction, your heart struggles to meet its quota. The blood left behind might even get backed up in your organs and very often the lungs.
Hearts grow stiffer as we age particularly among those who struggle with issues like hypertension, which overworks the muscle. Diastolic dysfunction occurs when the stiffness becomes too much and impedes the heart’s ability to pump.
What Is Diastolic Heart Failure?
Diastolic heart failure occurs when the left ventricle of a patient’s heart becomes stiffer than it should be, impedes pumping, and results in an inability to pump enough blood to meet your body’s needs.
A stiff ventricle prevents the heart muscle from relaxing the way a healthy heart does. Because it fails to rest, it struggles to fill up with blood as it pumps. Less blood in your left ventricle results in less blood pumping through your body while also leaving blood behind before it enters the heart.
Heart failure itself occurs when the blood backs up into the lungs, damming up the lungs, and ultimately not reaching the rest of your body.
Symptoms Associated with Diastolic Heart Failure
The signs of diastolic heart failure share commonalities with the signs of heart failure generally. You might experience:
- Shortness of breath
- Fast or irregular heartbeat
- Swelling in your lower extremities
- Swelling in your abdomen
- Regular coughing and wheezing
- Lack of appetite
- Frequent urge to urinate
What Causes Diastolic Dysfunction and Heart Failure?
Diastolic dysfunction is not unlike the effects of aging. Regardless of your health, your circular system, namely your heart and blood vessels, lose their elasticity thus creating some level of stiffness.
As a result, patients may experience diastolic heart failure without the presence of another cardiovascular disease.
However, some common underlying diseases and conditions directly impact the stiffening of your ventricles. These include:
- High blood pressure
- Coronary artery disease
Those who struggle to regulate their blood pressure already experience an overworked heart. The extra work your heart does to send blood coursing through your body may result in larger or thicker muscles. As muscles grow thicker in width, they become more likely to stiffen.
Diabetes also causes your heart muscles to thicken, which creates a similar effect to high blood pressure.
Coronary artery disease, obesity, and inactivity all require your heart to put in extra hard work to keep the blood flowing. Again, this may result in stiffness.
Diastolic heart failure stems from dysfunction, but not all patients diagnosed with dysfunction find wind up with heart failure. Early diagnosis and the appropriate medical treatment prevent the escalation of diastolic heart failure in many, but not all, cases.
Diagnosing Diastolic Heart Failure
If you experience the symptoms listed above, visit your doctor immediately.
If your doctor suspects diastolic dysfunction, they will take a medical history before choosing from a selection of tests. The signs of ventricular stiffening show up on common heart tests including:
- Blood tests
- Stress tests
- Heart catheterization
- Chest X-rays
Diastolic heart failure is trickier to diagnose. Unlike systolic heart failure, diastolic heart failure might not stand out on an echocardiogram once a patient stabilizes. In fact, by the time a patient is ready for testing, the heart might otherwise look normal if the doctor fails to look specifically for signs of diastolic dysfunction.
When doctors look for signs of diastolic heart failure, they look out for:
- Shortness of breath
- Weakness or fatigue
- Abnormal heart rate
- Enlarged heart
- Enlarged neck veins
Although these clinical signs are enough to warrant further exploration, doctors need to confirm a second piece of the puzzle: a normal ejection fraction.
The ejection fraction, or the percentage of blood pumped with each beat of your heart, normally runs about 55-60%. People with systolic heart failure will have ejection fractions below 50%. People with diastolic heart failure usually have a normal or even high ejection fraction. Unfortunately, it’s not possible to see signs of an abnormal ejection fraction on an x-ray. Specialists commonly use echocardiography for this purpose, but doctors might also choose:
- Nuclear testing
- Cardiac CT
- Cardiac MRI
Because of the difficulties associated with identifying signs of diastolic heart failure in stabilized patients, your doctor might decide to order additional testing, like a plasma BNP or further cardiopulmonary testing.
Treating Diastolic Dysfunction and Heart Failure
Treating diastolic heart failure means treating its underlying cause: diastolic dysfunction and the stiffening of the left ventricle wall. To accomplish this, doctors use a four-pronged approach to treatment that includes:
- Treating symptoms of heart failure
- Getting abnormal heart rates under control
- Managing high blood pressure
- Treating blockages and coronary artery disease
Heart Failure Treatment
The first step is to treat the heart failure itself. Treatment for diastolic heart failure differs from classic systolic heart failure because the interventions used in traditional cases may make the cause of diastolic heart failure worse. What is more, the recent evolutions in the understanding of diastolic heart failure mean that interventions are not as developed as they are for systolic heart failure.
Treating diastolic heart failure often means using limited options to control issues like edema, pulmonary congestion, or hypertension. Diuretics and hypertension drugs work well for removing excess water and sodium and lowering blood pressure. These are the most aggressive therapies presently available and also work for treating diastolic dysfunction.
Abnormal Heart Rate Treatment
Regulating an abnormal heart rate is the next step in the process because diastolic conditions already reduce the amount of blood pumped. Faster heart rates cause a decrease in the time the heart has to fill up between beats, so diastolic issues can worsen if the heart rate is too rapid. Unfortunately, if heart failure occurs, the body tries to compensate by increasing the heart rate, so it can become a vicious cycle.
Expect doctors to use beta-blockers or calcium channel blockers in an attempt to slow the heart rate to a safer pace. If you don’t respond well to those treatments or experience atrial fibrillation, the team takes further action to achieve a normal heart rhythm. Beta blockers and calcium channel blockers can also improve the diastolic function of the heart by making the muscle less stiff.
High Blood Pressure Treatment
High blood pressure, or hypertension, plays a crucial role in cardiac conditions of all kinds and particularly in diastolic heart failure. High blood pressure leads to bulky, inflexible muscles, which causes diastolic heart issues.
Treatment for high blood pressure starts immediately and often carries on after you have left the hospital. Traditional hypertension medications like angiotensin II receptor blockers and calcium channel blockers usually do the trick.
Evidence also suggestions that these medications may slowly reverse some muscle thickness and stiffness. However, the most important use is in controlling your blood pressure.
Coronary Artery Disease Treatment
If coronary artery disease is present, doctors usually recommend treatment that will relieve ischemia at the same time as they treat diastolic symptoms. Beta blockers and calcium blockers reduce the work of pumping and can improve the mismatch between supply and demand that results in ischemia.
Coronary artery disease and ischemia exacerbate issues in the heart’s ability to pump properly. Ischemia, in particular, indicates a blood flow shortage that impairs your metabolism by restricting the oxygen and nutrients carried in your blood. Some patients may even suffer from combined systolic and diastolic heart failure, especially after a heart attack.
Protect Yourself from Diastolic Heart Failure
Not everyone who experiences diastolic dysfunction ends up in diastolic heart failure. Early treatment and careful management of your blood pressure reduce your chances by preventing your heart from overworking and becoming and stiffer in the process.
These heart health management tools are critical. Diastolic heart failure is a life-threatening cardiac disease that is still hard to catch in some cases. Moreover, unlike systolic heart failure, there are not yet any direct treatments beyond symptom management.
If you have high blood pressure or if hypertension runs in your family, then it’s essential to manage your lifestyle to control this problem before diastolic dysfunction occurs. A low-salt diet with plenty of exercise and sleep helps regulate your blood pressure before it becomes a problem.