Chronic Diastolic Heart Failure (ICD-10: I50.31)

Introduction

Chronic Diastolic Heart Failure (HFpEF - Heart Failure with preserved Ejection Fraction) is a condition where the heart's ability to relax and fill properly is impaired, leading to symptoms of heart failure despite a normal ejection fraction.

Causes

  • Hypertension – Long-term high blood pressure stiffens the heart muscle.
  • Aging – With age, the heart can become less flexible.
  • Diabetes – High blood sugar levels damage the heart muscle.
  • Obesity – Excess weight puts extra strain on the heart.
  • Coronary artery disease – Reduced blood supply can impair relaxation.

Symptoms

  • Shortness of breath (especially during exertion or at night)
  • Fatigue and weakness
  • Swelling in legs, ankles, or abdomen
  • Rapid or irregular heartbeat

Diagnosis

  • Echocardiography – Assesses diastolic function and ejection fraction.
  • BNP or NT-proBNP tests – Biomarkers that indicate heart strain.
  • ECG & Stress Test – Detects electrical and functional issues. MRI and cardiac catheterization may be used in complex cases.

Treatment

Lifestyle Modifications

  • Blood pressure control: Essential for reducing heart stiffness.
  • Regular exercise: Improves heart function.
  • Low-sodium diet: Reduces fluid retention.
  • Weight management: Critical in obesity-related cases.

Medications

  • Diuretics – Helps reduce fluid overload.
  • Beta-blockers – Lowers heart rate and improves relaxation.
  • ACE inhibitors/ARBs – Helps with blood pressure control.
  • SGLT2 inhibitors – Newly recommended for heart failure and diabetes.

Advanced Therapies

  • Implantable devices – Such as pacemakers in some cases.
  • Heart transplant (rare cases) – If severe symptoms persist despite treatment.

Conclusion

Chronic diastolic heart failure requires a multidisciplinary approach, including lifestyle changes, medications, and careful monitoring. Proper management can significantly improve quality of life and reduce complications.

Source recommendations

1. American College of Cardiology/American Heart Association Heart Failure Guidelines

  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/35363499/

2. European Society of Cardiology Guidelines on Heart Failure

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
  2. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
  4. https://academic.oup.com/eurheartj/article/44/37/3627/7246292
  5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines

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