Diastolic Heart Failure: Symptoms, Causes, Treatment

What are the symptoms of diastolic heart failure?

Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), occurs when the heart’s ventricles do not relax properly, leading to inadequate filling of the heart with blood. The symptoms of diastolic heart failure are often similar to those of systolic heart failure and can include:

1. Shortness of breath: This can occur during exertion or at rest. It may be more noticeable when lying flat, a condition known as orthopnea. Patients might also experience paroxysmal nocturnal dyspnea (waking up at night short of breath).
2. Fatigue and weakness: Reduced cardiac output can lead to decreased blood flow to the muscles and organs, causing general tiredness and lack of energy.
3. Swelling (edema): This can occur in the legs, ankles, feet, and sometimes the abdomen (ascites) due to fluid buildup.
4. Rapid or irregular heartbeat (palpitations): The heart may try to compensate for the reduced blood flow by beating faster or irregularly.
5. Persistent cough or wheezing: This can be a result of fluid buildup in the lungs, leading to a condition known as pulmonary congestion or pulmonary edema.
6. Difficulty concentrating or decreased alertness: Poor blood flow can affect brain function, leading to cognitive issues.
7. Increased need to urinate at night (nocturia): Fluid that accumulates in the legs during the day may return to the bloodstream when lying down, increasing kidney activity and urine production at night.
8. Reduced exercise tolerance: Patients may find it increasingly difficult to perform physical activities due to the above symptoms.

If you or someone you know is experiencing these symptoms, it is important to seek medical attention for proper diagnosis and management.

What are the causes of diastolic heart failure?

Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), occurs when the heart’s ventricles become stiff and do not relax properly, which affects their ability to fill with blood. Several conditions and factors can lead to diastolic heart failure:

1. Hypertension (high blood pressure): Chronic high blood pressure can cause the heart muscle to thicken (hypertrophy) and become stiff, impairing its ability to relax and fill with blood.
2. Aging: As people age, the heart muscle can become stiffer, making it harder for the ventricles to relax and fill properly.
3. Coronary artery disease: Reduced blood flow to the heart muscle due to blocked or narrowed coronary arteries can lead to damage and stiffening of the heart muscle.
4. Diabetes: Diabetes can lead to changes in the heart muscle, including increased stiffness and impaired relaxation.
5. Obesity: Excess body weight increases the workload on the heart and can contribute to the development of hypertension and diabetes, which are risk factors for diastolic heart failure.
6. Atrial fibrillation: This irregular heart rhythm can affect the filling of the heart’s ventricles and contribute to diastolic dysfunction.
7. Left ventricular hypertrophy: Thickening of the heart’s left ventricle can occur due to conditions like hypertension or aortic stenosis, leading to diastolic dysfunction.
8. Pericardial disease: Conditions affecting the pericardium (the sac surrounding the heart) can restrict the heart’s ability to relax and fill properly.
9. Restrictive cardiomyopathy: This condition involves the stiffening of the heart muscle, which can lead to diastolic heart failure.
10. Myocardial ischemia: Reduced blood flow to the heart muscle, often due to coronary artery disease, can cause stiffness and impaired relaxation of the ventricles.
11. Valvular heart disease: Conditions such as aortic stenosis or mitral regurgitation can lead to changes in the heart muscle, affecting its ability to relax properly.
12. Inflammatory conditions: Diseases such as myocarditis or sarcoidosis can cause inflammation and stiffening of the heart muscle.
13. Genetic factors: Some inherited conditions can affect the structure and function of the heart, leading to diastolic dysfunction.

What is the treatment for diastolic heart failure?

Diastolic heart failure (DHF) is a type of heart failure characterized by impaired relaxation and filling of the left ventricle, leading to elevated left ventricular end-diastolic pressure and reduced stroke volume. The treatment of DHF is focused on managing symptoms, improving cardiac function, and reducing mortality. Here are some common treatment options for DHF:

1. Medications:
   • Diuretics: to reduce fluid buildup and relieve congestion.
   • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): to reduce blood pressure and improve cardiac function.
   • Beta blockers: to slow the heart rate and reduce the workload on the heart.
   • Calcium channel blockers: to reduce blood pressure and improve cardiac function.
   • Aldosterone antagonists: to reduce fluid buildup and improve cardiac function.
2. Lifestyle modifications:
   • Salt restriction: to reduce fluid retention.
   • Fluid intake restriction: to reduce fluid overload.
   • Weight loss: if overweight or obese, to reduce strain on the heart.
   • Regular exercise: to improve cardiac function and reduce symptoms.
3. Cardiac resynchronization therapy (CRT):
   • A device that helps coordinate the pumping of the heart’s chambers, which can improve cardiac function in some patients with DHF.
4. Ventricular assist devices (VADs):
   • A mechanical pump that takes over some or all of the pumping function of the heart, which can be used as a bridge to transplant or as destination therapy for patients with advanced DHF.
5. Heart transplantation:
   • In cases where other treatments are not effective or not tolerated, heart transplantation may be considered for patients with advanced DHF.
6. Cardiac rehabilitation:
   • A comprehensive program that includes exercise training, education, and lifestyle modifications to help patients with DHF manage their condition and improve their overall health.
7. Intravenous inotropes:
   • Medications that increase the contractility of the heart muscle, which can help improve cardiac function in some patients with DHF.

It’s essential to note that the specific treatment plan for DHF will depend on the individual patient’s condition, severity of symptoms, and response to treatment. A multidisciplinary team of healthcare providers, including cardiologists, primary care physicians, and other specialists, will work together to develop a personalized treatment plan for each patient.

How long can you live with diastolic heart failure?

The prognosis for patients with diastolic heart failure (DHF) can vary depending on the severity of the condition, overall health, and response to treatment. While there is no cure for DHF, with proper management and treatment, many patients can live for years with this condition.

On average, the life expectancy for patients with DHF is similar to that of the general population. A study published in the Journal of the American College of Cardiology found that the median survival time for patients with DHF was around 7-10 years.

However, the prognosis for DHF can be influenced by several factors, including:

1. Severity of disease: Patients with more severe DHF may have a poorer prognosis than those with milder forms of the condition.
2. Presence of comorbidities: Patients with co-existing conditions such as hypertension, diabetes, kidney disease, or chronic obstructive pulmonary disease (COPD) may have a worse prognosis than those without these conditions.
3. Response to treatment: Patients who respond well to treatment and are able to control their symptoms may have a better prognosis than those who do not respond as well to treatment.
4. Age: Older patients may have a poorer prognosis than younger patients due to age-related decline in cardiac function and increased risk of comorbidities.

To give you a better idea of what to expect, here are some general guidelines on life expectancy for patients with DHF:

• Mild DHF: 10-15 years
• Moderate DHF: 5-10 years
• Severe DHF: 2-5 years

Keep in mind that these are general estimates and individual outcomes can vary significantly. It’s essential for patients with DHF to work closely with their healthcare provider to manage their condition and make lifestyle changes to reduce symptoms and improve overall health.