What Is Diastolic Heart Failure?

The heart has one main function: pumping blood throughout your body. It accomplishes this thanks to its unique anatomical structure that consists of four hollow muscular chambers that relax and fill with blood and then contract, ejecting blood out of the heart. The heart does this anywhere from 60 to 100 times per minute on average, with enough force to push blood continuously through the body.

The lower left chamber of the heart, known as the left ventricle, is the larger of the four chambers, and that is because it is the chamber responsible for pushing oxygen-rich blood to every tissue of the body. This is an important job, and if something compromises left ventricle function, it can cause problems within the body.

Below is a closer look at a specific kind of ventricular dysfunction known as diastolic heart failure and everything you need to know about it, including its causes, symptoms, how it is diagnosed, and how it is managed.

What Is Diastolic Heart Failure?

Diastolic heart failure, also known as heart failure with preserved ejection fraction, is a type of chronic heart failure that occurs when the left ventricle is unable to relax and fill properly.

This becomes problematic because the heart is not pumping the same amount of blood per stroke as it would if the chamber could fill completely. The result is reduced cardiac output and a reduced amount of blood going out to the body with each heartbeat.

How Do Diastolic and Systolic Heart Failure Differ?

If you have taken your blood pressure, you are likely familiar with systolic and diastolic pressures. Still, as a refresher, blood pressure is written in the format of systolic pressure in mmHg over diastolic pressure in mmHg.

Systolic pressure refers to the amount of pressure exerted on the walls of your arteries when the left ventricle is contracting and forcing blood into the body. Diastolic pressure refers to the pressure exerted on the walls of the arteries when the left ventricle is relaxed.

The same convention is utilized when describing the type of left-sided heart failure. Diastolic heart failure is heart failure due to an inability of the left ventricle to fill during diastole. Systolic heart failure is heart failure that is due to a reduced contractile force of the left ventricle during systole.

This reduced force causes a reduced left ventricular ejection fraction which is why this kind of heart failure is referred to as heart failure with reduced ejection fraction.

Systolic and diastolic heart failure both tend to refer to left-sided heart failure, but they are worth differentiating as they both have slightly different approaches when it comes to treatments and determining potential causes.

What Causes Diastolic Heart Failure?

Diastolic heart failure can develop for a number of reasons. The most common causes include heart valve disease (HVD), hypertrophic cardiomyopathy, coronary artery disease, and high blood pressure (hypertension).

A reduced ability of the heart to relax generally results from a left ventricle that has experienced an increase in size from having to compensate for increased systemic pressure due to blockages, poor vasculature, and atherosclerosis. These factors can also contribute to the stiffening of the left ventricle and reduced blood flow to the area of the heart.

What Are the Symptoms of Diastolic Heart Failure?

A failure of the heart to fill adequately between beats has a distinct set of symptoms. Below is a closer look at some common symptoms associated with diastolic heart failure.

Wheezing or Coughing

The left side of the heart is directly fed by the major veins of the lungs, known as the pulmonary veins. These veins contain blood that has been freshly oxygenated by the alveoli in the lungs and is ready to be dispersed through the body.

When the diastolic function is inhibited, it causes a backup of fluids to the lungs. Heart failure on the left side causes a buildup of fluids in the structures immediately before it, which ends up being the lungs. Fluid accumulation can cause pulmonary symptoms, including wheezing and coughing during the early stages.

Swelling in the Legs, Ankles, or Feet

Another common symptom of heart failure is swelling in the lower extremities. When fluid is congested due to the slowed movement of blood through the left ventricle, it causes a backup of blood in the lungs, forcing the right side of the heart to work harder. This can eventually lead to right-sided heart failure causing a backup of unoxygenated blood coming back to the heart to be pumped through the lungs.

The legs, ankles, and feet tend to fall victim to edema since they are much lower than the level of the heart. With poor circulation, there simply is not enough force to force the fluids back up to the heart, so it ends up pooling in the lower extremities.

Shortness of Breath

As described previously, pulmonary edema is often associated with left-sided heart failure. Fluid accumulations in these tissues can reduce pulmonary efficiency and causes you to feel short of breath.

Dizziness

The left ventricle pumps oxygenated blood throughout your body, including your brain. With diastolic heart failure, your heart is not pumping as much blood as it should be per beat. This may lead to a situation where your brain receives too little oxygenated blood and cause symptoms such as dizziness.

Tiredness

Fatigue is a common symptom of nearly all forms of heart failure. Ideal blood flow is what all your tissues work best with. When blood flow is hindered, tissues throughout your body feel the effects which can cause you to feel drowsy and fatigued when you otherwise shouldn’t be.

How Is Diastolic Heart Failure Diagnosed?

Heart failure is a fairly common condition of the heart, and while there are definitive criteria to make a diagnosis, many individuals go undiagnosed. Heart failure can be elusive, and below is a closer look at some of the most common techniques utilized to help make a diagnosis of diastolic heart failure.

Blood Tests

These can help determine if any underlying conditions may be contributing to your heart failure. Heart failure tends not to come about overnight, and a blood test can inform you about your cardiovascular health.

A test looking at natriuretic peptide, for example, can provide information on how well the heart is working. Also, tests like cholesterol testing could help to determine if atherosclerosis may be to blame.

Electrocardiogram (ECG)

This test records the electrical activity of your heart and can help detect any abnormalities such as arrhythmias like atrial fibrillation or other irregular heart rhythms that may impede the proper cardiac cycle of the heart.

Echocardiography: This imaging technique uses sound waves to create a detailed image of your heart, allowing your doctor to see how well the heart muscle is functioning.

The echocardiogram, also sometimes referred to as a doppler, provides a near real-time video that can be reviewed for functional and structural issues of the heart.

Cardiac Catheterization

This procedure involves threading a thin tube through a blood vessel to the heart, allowing your doctor to see inside the heart and measure blood flow. The catheter is typically put into place, and a dye is injected into the area of interest in the heart.

The dye is then visible through X-rays. This technique is more invasive but can provide valuable information on how fluid is able to move through the heart.

How Is Diastolic Heart Failure Treated?

Treatment for diastolic heart failure typically involves a combination of lifestyle changes, medications, and procedures. Unfortunately, heart failure cannot be completely reversed, but these interventions can help slow disease progression.

Medications that are commonly utilized in treating diastolic heart failure include diuretics to help remove excess fluid from the body, ACE inhibitors or ARBs to help improve heart function by lowering blood pressure, and beta blockers to help slow the heart rate and improve blood flow. Procedures to fix physical abnormalities may also help treat heart failure.

Making positive lifestyle modifications is perhaps one of the most important ways that heart failure is managed, and cardiac rehab is one of the best ways to facilitate these changes.

Cardiac rehab is a program designed around improving overall cardiovascular health through patient education, monitored exercise programs, and mental health support. These actions don’t cure heart failure, but they can help to slow its progression and reduce the likelihood of developing further cardiac complications.

If you are considering cardiac rehab, consider doing it with Carda Health. As a virtual cardiac rehab provider, you can receive the same things you would from an in-person rehab program without the hassle of driving to a rehab center. Getting started is easy, and in four easy steps, you could be on a path to a healthier you.

The Bottom Line

Diastolic heart failure is a type of heart failure that occurs when the left ventricle is unable to relax and fill properly during diastole. This can lead to a reduced ability of the heart to pump blood to the body's organs and tissues. Causes of diastolic heart failure include high blood pressure, coronary artery disease, cardiomyopathy, and valve disease.

Symptoms include wheezing or coughing, swelling in the legs, ankles, or feet, shortness of breath, dizziness, and tiredness. Treatment typically involves a combination of lifestyle changes, medications, and surgical procedures if needed.

Sources:

Heart rate: What's normal? | Mayo Clinic.

Types of Heart Failure | American Heart Association

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Cardiac Rehabilitation: Improving Function and Reducing Risk | NCBI

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