Systolic vs. Diastolic Heart Failure: What's the Difference?

The left ventricle is the biggest and strongest of your heart's four chambers. Its job is to pump oxygen-rich blood that it receives from the lungs to the organs and tissues in the rest of your body. 

Systolic and diastolic heart failure are cardiovascular diseases that affect the left ventricle of the heart. What are systolic and diastolic heart diseases, and what is the difference? 

Carda is here to explain the causes, signs and symptoms, and treatment options for each. Read on to learn how to address these left-sided heart diseases and improve your overall heart health. 

What Is Systolic Heart Failure?

Systolic heart failure, also known as heart failure with reduced ejection fraction, is a type of left-sided heart disease that occurs when the left ventricle weakens and can no longer pump enough blood effectively to the rest of your body. When the left ventricle weakens, it fails to effectively squeeze (contract) during each heartbeat, resulting in reduced blood circulation to the rest of the body. 

The other name for systolic heart failure — reduced ejection fraction — refers to a reduced percentage of blood being pumped by the left ventricle to the rest of the body. The ventricular ejection fraction measures how much blood your heart muscle's left ventricle pumps out with every beat as a percentage in order to evaluate how successfully your heart pumps blood to the rest of your body. 

An ejection fraction range between 55 to 70% is generally within normal limits, whereas an ejection fraction value below 50% can be a sign of systolic heart failure.

What Are the Symptoms of Systolic Heart Failure?

The most common symptom that can indicate a person has systolic heart failure is shortness of breath, also known as dyspnea. This symptom can be a good marker of how serious a person's systolic heart failure is. 

Typically, in milder cases of this particular left-sided heart muscle disease, a person might only experience dyspnea while physically exerting themselves. However, as systolic heart failure progresses, they may notice that they experience shortness of breath more frequently. In more severe cases, a person might experience shortness of breath while at rest. 

The weakened left ventricle can also cause fluid buildup in several different areas. Firstly, it can lead to fluid buildup in the lungs, which can cause a persistent cough or wheeze. This heart disease can also cause fluid retention in body parts such as the legs, feet, and abdomen. 

The poor circulation from systolic heart failure may result in symptoms such as chest pain, fatigue, dizziness, weakness, a rapid heart rate, nausea, decreased appetite, increased frequency in urination habits, and sudden weight gain. 

What Causes Systolic Heart Failure?

The leading causes of systolic heart failure are other underlying heart conditions that damage the left ventricle. A damaged left ventricle can scar the heart muscle, and the ventricle may stretch or become stiff. This damage often weakens the left ventricle and, in turn, can greatly diminish its ejection fraction abilities. 

Pre-existing heart conditions or heart-related medical issues that can lead to systolic heart failure include:

  • Coronary artery disease (CAD)
  • High blood pressure (hypertension)
  • An abnormal heart rhythm (arrhythmia)
  • A heart attack
  • Heart muscle inflammation (myocarditis)
  • Heart valve disease
  • Aortic stenosis
  • Diabetes

Excessive alcohol consumption, smoking, or a lifestyle with little physical activity and an unhealthy diet are all additional risk factors for systolic heart failure. 

What Is Diastolic Heart Failure?

Diastolic heart failure is another type of left-sided heart disease that occurs when the left ventricle stiffens and fails to relax. With this increased stiffness, the ventricle cannot fill up with enough blood as it pumps, so your body, in turn, receives less blood from the heart. 

Diastolic heart failure is also known as heart failure with preserved ejection fraction. It has more to do with the amount of blood your heart receives as it pumps between each heartbeat rather than the pumping strength of your heart muscle. 

What Are the Symptoms of Diastolic Heart Failure?

Diastolic heart failure has many of the same signs and symptoms as systolic heart failure. 

Symptoms of heart failure for diastolic dysfunction may include shortness of breath, fatigue, weakness, dizziness, a persistent cough or wheeze, arrhythmia, increased urination, nausea, a lack of appetite, and swelling in the feet, ankles, or abdomen areas. 

What Causes Diastolic Heart Failure?

Older age can cause diastolic heart failure due to a reduction in the elasticity of the heart and blood vessels. This can cause the left ventricle to become stiff. 

Additionally, diastolic heart failure often presents due to an underlying condition like coronary artery disease, hypertension, obesity, or diabetes. Kidney disease or obstructive sleep apnea are two additional medical conditions that can cause diastolic heart failure. 

Can You Have Both Systolic and Diastolic Heart Failure?

While it is very rare, a person can develop a combination of both systolic and diastolic heart failure. However, it is far more common for someone to have one or the other type of left-sided heart disease. The two are closely related and easy to confuse. 

How Are Systolic and Diastolic Heart Failure Related?

Both systolic and diastolic heart failure involve a decrease in the heart muscle’s ability to pump blood to the rest of the body, which can cause various symptoms to present. 

However, they differ slightly in why they diminish blood flow and circulation. Systolic heart failure involves a decrease in your heart's ability to contract, or pump, blood out. The systolic blood pressure measures how much pressure or force the heart exerts when it squeezes blood out with each heartbeat. 

In contrast, diastolic heart failure involves a decrease in your heart's ability to fill up with blood between each heartbeat. The diastolic blood pressure measures how much pressure develops in the arteries as the heart relaxes between each beat. 

Whether a person has systolic or diastolic heart failure all comes down to whether their heart experiences issues with pumping or relaxing in its rhythm cycle. 

Are Systolic and Diastolic Heart Failure Treated Differently?

Systolic and diastolic heart failure have many overlapping treatment methods when it comes to lifestyle changes and medical procedure options. However, when it comes to medications, there are some differences in how systolic and diastolic heart failure are treated. 

Let’s take a look at some different treatment options. 


As far as medications go, there is very little research on medications that can effectively target and treat diastolic heart failure.

However, there is a lot of research regarding medication options for systolic heart failure. Medication treatment options for systolic heart failure may include angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), which are blood-pressure-lowering options that help relax blood vessels. 

Additionally, your healthcare provider may prescribe beta blockers to help regulate your heartbeat and angiotensin receptor-neprilysin inhibitors (ARNIs) to help relax your blood vessels and mitigate fluid retention throughout your body. 

Your healthcare provider may also prescribe some of these medications if you have diastolic heart failure due to an underlying condition like high blood pressure. They may also offer medications to relieve other symptoms (for both systolic or diastolic heart disease), such as a diuretic to help alleviate fluid retention in your body. 


There are a handful of different surgery options when it comes to treating systolic heart failure. A cardiologist can plant a pacemaker device that will monitor and regulate a person's heartbeat. They may alternatively place an implantable cardioverter defibrillator (ICD), which can also monitor the heartbeat. If the heart starts beating rapidly, the ICD will electrically shock the heart to get the rhythm back on its normal track.

Another option for placement to help treat systolic heart failure is a left ventricular assist device (LVAD). An LVAD will assume pumping to take over the heart muscle's pumping motions and ensure a regular heartbeat.

Other surgery options include those that attempt repairs, like a heart valve repair surgery or a more involved coronary bypass surgery. Sometimes, a cardiologist may recommend a heart transplant instead, which would replace a person's existing heart with an all-different heart from a donated source. 

When it comes to diastolic dysfunction, an angioplasty surgery could be beneficial as a management strategy. With an angioplasty procedure, the surgeon uses a catheter to thread a small balloon through the blocked artery and inflates a balloon to open up the blockage. Sometimes the surgeon also puts in a stent to help ensure that the newly opened artery remains open. 

A heart valve repair or a heart valve replacement surgery can also be beneficial options for a diastolic heart failure diagnosis.

Lifestyle Changes

In addition to medication or surgery options, lifestyle changes, such as a heart-healthy diet, stress management, and physical exercise, can be beneficial. Signing up for a cardiac rehab program is a great way to incorporate all of these lifestyle changes under the guidance of a provider and an exercise physiologist. 

Carda offers an outpatient all-virtual cardiac rehabilitation program where you can work with an expert physiologist and provider, with your own vitals monitoring equipment, from the comfort of your own home. Get started today to get your at-home cardiac kit and to be paired with a physiologist.

The Bottom Line

Systolic and diastolic heart failure are two different types of left-sided heart failure that occur when the heart has a severely diminished ability to pump blood to the rest of the body. Systolic heart failure occurs when the heart has trouble pumping during its heartbeat cycle, whereas diastolic heart failure occurs when the heart has trouble relaxing during the regular heartbeat cycle. 

Systolic and diastolic heart failure have similar treatment and management options, including medications, surgeries, and cardiac rehabilitation. Talk to your healthcare provider today to get a referral for cardiac rehabilitation to enhance your overall heart health. 


Types of Heart Failure | American Heart Association (AHA)

Heart failure - Symptoms and causes | Mayo Clinic

Systolic and diastolic heart failure: differences and similarities | NIH

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