What is Diastolic Heart Failure?

Diastolic heart failure, technically referred to as "heart failure with preserved ejection fraction" (HFpEF), is a condition where the lower left chamber of the heart (left ventricle) is not able to fill properly with blood during the diastolic phase, reducing the amount of blood pumped out to the body. The diastolic phase is when the heart relaxes and fills with blood.

Diastolic heart failure occurs if the left ventricle muscle becomes stiff or thickened. The heart must increase pressure inside the ventricle to fill it. Over time, this causes blood to build up inside the left atrium, and then in the lungs, leading to fluid congestion and symptoms of heart failure.

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of diastolic heart failure. The American Heart Association awarded us with the Get With the Guidelines® Bronze Award in 2016 for consistent application of quality measures in treating heart failure. 

You will appreciate timely appointments and respectful attention to your concerns, all in a positive and friendly atmosphere. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Symptoms

Diastolic heart failure signs and symptoms can range from mild to severe, and may include:

• Awakening at night with shortness of breath
• Breathlessness or shortness of breath during exercise or when lying flat
• Coughing or wheezing, sometimes with white or pink phlegm
• Difficulty concentrating
• Fatigue
• Fluid retention causing swelling in the ankles, legs, feet and/or abdomen
• Lack of appetite and nausea
• Rapid or irregular heartbeat
• Sudden weight gain

Causes

The following can lead to diastolic heart failure development:

• Coronary artery disease
• Diabetes
• High blood pressure
• Obesity

Risk Factors

Risk factors that could contribute to diastolic heart failure include:

Aging: As a person gets older, the heart muscle tends to stiffen, preventing the heart from filling with blood properly.

Aortic stenosis: A narrowed opening of the aortic valve can cause the left ventricle to thicken/

Hypertrophic cardiomyopathy: This inherited heart muscle abnormality causes left ventricle walls to thicken.

Pericardial disease: This abnormality in the sac surrounding the heart can cause fluid to build up in the pericardial space or thicken the pericardium.

Diagnosis

To determine if a patient has diastolic heart failure, we ask questions about your medical history and do a physical exam. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Common procedures used for diastolic heart failure diagnosis include:

Blood test: Blood tests check the levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions.

Chest X-ray: A common imaging test of the lungs, heart and aorta.

Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves. 

Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.

Electrophysiology study: This test records the heart’s electrical activities and pathways. It can help find what’s causing heart rhythm problems and identify the best treatment. 

Stress testing: This test is conducted during exercise. If a person can't exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure. Exercise makes the heart work hard and beat fast while heart tests are administered.

Prognosis

Prognosis varies depending on the cause of diastolic heart failure, the severity a person’s symptoms and impairment, the degree to which other organ systems are involved, and his or her response to medications.

Treatment

Diastolic heart failure treatment options may include: 

Medication

Medications may be prescribed to treat or reduce symptoms of diastolic heart failure. They include:

• Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) and Angiotensin Receptor Blockers (ARBs), which relax blood vessels to improve blood flow. 
• Beta-blockers, which can reduce blood pressure and slow a rapid heart rhythm.
• Calcium-channel blockers and long-acting nitrates to relax blood vessels, especially those that feed the heart muscle.
• Diuretics to reduce your body’s fluid content by promoting urination.
• Vasodilators to open blood vessels if you cannot tolerate ACE inhibitors or ARBs.

Surgery and Other Procedures

If medications are not effective, your physician may recommend surgery. Diastolic heart failure surgery options include:

• Angioplasty: to open a blocked artery or surgery to repair a heart valve.
• Heart valve repair: heart valve repair or replacement can help to correct diastolic heart failure

Lifestyle Changes

While you cannot prevent all types of diastolic heart failure, you can take steps to lower your risks for diseases or conditions that can lead to or complicate the condition.

Be active: Moderate exercise helps circulation and decreases stress on your heart muscle.

Eat a healthy diet: Limit sugar, saturated fat, cholesterol and salt, and eat plenty of fruit, vegetables, whole grains and low-fat dairy products.

Get regular checkups: And, if you experience new or changing symptoms or side effects from medications, see your physician.

Maintain a healthy weight: Losing weight and maintaining a healthy weight puts less stress on the heart.

Reduce your alcohol intake: In some cases, you may need to stop drinking entirely. If you can drink, keep your intake low.

Stop smoking: Smoking damages blood vessels, raises blood pressure, reduces the amount of oxygen in the blood and makes the heart beat faster.

Take your medications as prescribed:  If you’ve been prescribed a medication for diastolic heart failure or a causative condition, be sure to take it as prescribed. 

Complications

Complications of diastolic heart failure can lead to other conditions, including:

Anemia: This condition that develops when your blood lacks enough healthy red blood cells or hemoglobin can cause weakness and fatigue. 

Atrial fibrillation: This irregular heart rhythm can increase the risk of stroke and blood clots.

Cardiac cachexia: This unintentional weight loss can be life-threatening without supplemental nutrition.

Impaired kidney function: Decreased kidney function is common in patients with heart failure, and it increases the risks for heart complications, hospitalization and death.

Leg venous stasis and ulcers: Poor circulation can cause skin to thicken, change color and look shiny. Hair may fall out and ulcers can develop if you sustain an injury.

Stroke: If the blood supply to the brain is decreased or cut off, the brain can be deprived of oxygen, causing cells to die.

Diastolic vs Systolic Heart Failure

Diastolic heart failure and systolic heart failure impact the heart in different ways, which leads to different treatments for each type of heart failure.

• Systolic heart failure. Also known as “heart failure with reduced ejection fraction (HFrEF),” this form of the condition means that the left ventricle is unable to generate enough force to move blood around the body.
• Diastolic heart failure. Technically referred to as “heart failure with preserved ejection fraction (HFpEF),” diastolic heart failure is characterized by the left ventricle’s inability to relax and allow the inflow of sufficient blood in preparation for the next beat.

As far as treatments for systolic heart failure, there is a set of medications that are typically prescribed. Devices like an implantable cardiac defibrillator may also be used. With diastolic heart failure, treatment tends to involve identifying and treating the condition or conditions (hypertension, diabetes, etc.) behind the heart problem. With either type of heart failure, your doctor will likely recommend lifestyle changes.