Understanding Diastolic Heart Failure

Introduction

Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF) , is a condition where the heart muscle becomes stiff and does not relax properly during the filling phase. This leads to increased pressure in the heart chambers and a reduced ability to pump blood efficiently, even though the heart's squeezing function (ejection fraction) remains normal.

Causes and Risk Factors

Several factors can contribute to the development of HFpEF: - Hypertension (high blood pressure) – Causes the heart muscle to thicken and stiffen. - Aging – The heart naturally becomes less flexible over time. - Diabetes – Can lead to stiffening of the heart tissue. - Obesity – Increases workload on the heart. - Chronic kidney disease – Leads to fluid retention and heart strain. - Coronary artery disease – Reduces blood supply to the heart muscle.

Symptoms of HFpEF

Common symptoms include: - Shortness of breath, especially during exertion or lying flat. - Fatigue and reduced exercise tolerance. - Swelling in the legs, feet, or abdomen due to fluid retention. - Frequent nighttime urination (nocturia). - Heart palpitations.

Diagnosis

Diastolic heart failure is diagnosed through: - Echocardiogram – Evaluates heart size, function, and stiffness. - Electrocardiogram (ECG) – Identifies abnormalities in heart rhythm. - Blood tests (e.g., BNP, NT-proBNP) – Measure heart stress markers. - Chest X-ray – Detects fluid buildup in the lungs. - Stress test – Assesses heart function during activity.

Treatment Approaches

Lifestyle Modifications

• Maintain a healthy diet (low in salt, rich in vegetables and whole grains).
• Engage in regular physical activity (such as walking or swimming at moderate intensity).
• Manage high blood pressure, diabetes, and obesity effectively.
• Limit alcohol consumption and quit smoking.

Medications

• Diuretics – Help remove excess fluid and reduce symptoms.
• Beta-blockers – Reduce heart rate and improve relaxation.
• ACE inhibitors/ARBs – Lower blood pressure and reduce stress on the heart.
• Mineralocorticoid receptor antagonists – Improve outcomes in some patients with HFpEF.

Prognosis and Outlook

HFpEF is a chronic condition but can be managed effectively with lifestyle changes and medical treatment. Early diagnosis and appropriate management significantly improve quality of life and reduce hospitalizations.

Conclusion

Diastolic heart failure is a significant health concern, especially in older adults. Understanding the causes, symptoms, and treatment options can help patients take control of their condition and improve overall heart health. Regular check-ups with a cardiologist are essential for optimal management.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines for the Management of Heart Failure

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://www.acc.org/Guidelines
3. https://www.jacc.org/doi/10.1016/j.jacc.2023.12.024
4. https://www.acc.org/education-and-meetings/products-and-resources/features/global-cv-institute/heart-failure-guidelines
5. https://pubmed.ncbi.nlm.nih.gov/23747642/

2. European Society of Cardiology Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://pubmed.ncbi.nlm.nih.gov/34447992/
3. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
4. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
5. https://pubmed.ncbi.nlm.nih.gov/27206819/