Diastolic Dysfunction and Diastolic Heart Failure

What are diastolic dysfunction and diastolic heart failure?

The heart squeezes and relaxes each time it beats. The squeezing part of this cycle is called systole. The relaxation part is called diastole. When the ventricles (the heart's major pumping chambers) squeeze, they push blood out of the heart and into the blood vessels. After the ventricles have finished squeezing, they relax. This allows them to refill with blood to get ready to squeeze again.

The heart muscle can become stiff, making it hard for the ventricles to relax completely. This problem is called diastolic dysfunction. Pressure in the heart rises, and blood can back up into blood vessels in the lungs. When diastolic dysfunction causes symptoms such as shortness of breath, it is called diastolic heart failure.

How does it occur?

Diastolic dysfunction and diastolic heart failure may be caused by:

• high blood pressure
• hypertrophic cardiomyopathy (the walls of the heart become thick and stiff)
• aortic stenosis (narrowing in one of the heart valves)
• coronary artery disease
• restrictive cardiomyopathy (scars or deposits that make the heart muscle stiff)
• aging.

Diastolic dysfunction is very common. Many adults older than 70 have it. In most people with diastolic dysfunction, the problem is not severe enough to cause diastolic heart failure.

What are the symptoms?

Diastolic dysfunction may not cause symptoms. If it does, the most common symptoms are:

• shortness of breath or trouble breathing, at first during exercise and later with any activity or even when you are resting
• waking up at night with trouble breathing or having a hard time lying flat in bed because you are short of breath
• unusual weight gain or swelling in the legs and ankles
• fast or irregular heartbeat.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You may have some tests, such as:

• chest X-rays to look for fluid in the lungs and to see the size of your heart
• an electrocardiogram (ECG), which is a recording of the electrical activity of your heart
• an echocardiogram, which is a sound-wave test that can show heart size, heart function, and possible heart valve disease.

How is it treated?

The first step is to find the cause of the problem and treat the cause. This may mean treating high blood pressure with a change in lifestyle or medicine, or having surgery to replace a damaged heart valve.

You will probably need to take medicine. Medicines your healthcare provider may prescribe include:

• A diuretic to help you get rid of extra fluid in your body by urinating more.
• A beta blocker or calcium channel blocker to relax the heart muscle.
• A vasodilator to make the blood vessels open up. Increasing the size of the blood vessels allows more blood to flow through them. This lowers blood pressure slightly and lessens the workload of the heart.
• An ACE inhibitor to relax blood vessels and lower blood pressure. This helps the heart to pump more blood out to the body.

How can I take care of myself?

If you have diastolic heart failure, learn to live within the limits of your condition. The following guidelines may help:

• Get enough rest, shorten your working hours if possible, and try to reduce the stress in your life. Anxiety and anger can increase your heart rate and blood pressure. If you need help with this, ask your healthcare provider.
• Check your pulse rate daily.
• Learn how to take your own blood pressure or have a family member learn how to take it.
• Accept the fact that you will need to take medicines for your heart and limit the salt in your diet for the rest of your life.
• Find a way to make sure that you take your medicines on time.
• Weigh yourself at least every other day, at the same time of day if possible. Contact your healthcare provider if you gain more than 3 pounds in 1 week, or if you keep gaining weight over weeks to months. Weight gain may mean your body is having trouble getting rid of extra fluid.
• Follow your healthcare provider's advice on how much fluid you should drink.
• Make sure that your activities do not cause you to become too tired or short of breath.
• Keep all of your appointments with your healthcare provider.