Presenting Problems in Cardiovascular Disease

Diastolic Heart Failure

Last updated on May 8th, 2020

Diastolic Heart Failure: Causes, Symptoms and Prevention

Diastolic heart failure can be defined as heart failure due to increased resistance in the diastolic filling of the heart. it is usually given as a diagnosis of exclusion when clinical features are suggestive and other pathologies and systolic dysfunction have been excluded.

Diastolic heart failure has latterly emerged as a distinct clinical essence and is characterized by clinical features signifying of heart failure but with minimal or no systolic dysfunction. DHF may occur in up to 50% of patients with heart failure and is associated with the elderly, women, hypertension, obesity, diabetes mellitus, and the presence of concentric left ventricular hypertrophy.

As noted previously, up to 50% of older Heart failure patients have preserved left ventricular systolic function; this represents a major clinical problem because few large-scale clinical trials have focused on the treatment of this disorder.

Diuretics are effective in relieving congestion and edema, but they must be used cautiously because patients with diastolic dysfunction are dependent on a sufficient preload to maintain adequate stroke volume. Such patients are often “volume sensitive,” and are prone to developing pulmonary edema with modest volume overload, while volume contraction and prerenal azotemia may occur in response to over diuresis.

The only major trial reported to date that was specifically designed to address the treatment of patients with HF and preserved left ventricular systolic function is CHARM-Preserved (Candesartan 720 Rich in Heart Failure Assessment of Reduction in Mortality and Morbidity) (99). In this study, candesartan reduced Heart failure hospitalizations but had no effect on mortality in patients with class II-IV Heart failure and an ejection fraction >40%.

Pending results from several ongoing studies, candesartan should be considered first-line therapy for the treatment of older patients with HF and preserved left-ventricular systolic function. furthermore, data from the DIG ancillary study indicate that digoxin may reduce HF hospitalizations in patients with class II-III HF and an ejection fraction of 45%or greater (93,94). Thus, digoxin (cardiotonic agent)  may play a role in the management of patients with diastolic Heart failure unresponsive to other agents.

Symptoms and signs in Systolic heart failure

Symptoms of systolic heart failure

  • Dyspnoea
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Reduced exercise tolerance, lethargy, fatigue
  • Nocturnal cough
  • Wheeze
  • Ankle swelling
  • Anorexia

Signs of systolic heart failure

  • Cachexia and muscle wasting
  • Tachycardia
  • Pulsus Alternans
  • Elevated jugular venous pressure
  • Displaced apex beat
  • Right ventricular heave
  • Crepitations or wheeze
  • Third heart sound
  • Edema
  • Hepatomegaly (tender)
  • Ascites

Causes of diastolic heart failure

Hypertension

Hypertension is the second major cause of heart failure in Western society and often coexists with coronary artery disease. Indeed there is still no consensus on which of these is the most important etiological factor for heart failure. High blood pressure is particularly associated with heart failure in specific populations, including women, diabetics, and people of African origin. Furthermore, its causal role in the development of left ventricular hypertrophy makes it a very important etiologic factor in the development of diastolic heart failure.

Diabetes

It is one of the major causes of diastolic heart failure. It causes heart wall thickness and makes it stiffen.

Cardiomyopathy

The term cardiomyopathy is widely used in the context of heart failure and, at its most basic level, can be defined as a disease process involving cardiac muscle. It is traditionally reserved for intrinsic cardiac muscle disease in the absence of coronary artery disease, hypertension, valvular, congenital, and pericardial heart disease.

Cardiomyopathy can be divided into descriptive terms into three functional categories: dilated, hypertrophic, and restrictive. Dilated cardiomyopathy can be defined as heart muscle disease in which the predominant abnormality is dilation of the left ventricle (with or without right ventricular dilation).

It is the end consequence of numerous pathological insults on the heart, although in many cases it is unknown. It is the most common form of cardiomyopathy, highlighting the fact that the final response of the heart to sustained injury is a global chamber remodeling resulting in a globular heart with thinned walls, decreased systolic function, and functional valvular regurgitation.

Obesity

Obesity makes your body inactive which means your heart has to work harder to pump the blood.

Diagnosis

To know whether you have Diastolic heart failure or not your doctor will examine you then will ask you about your medical history and run some tests. Those tests that doctor might run includes:

  • Electrocardiogram (ECG)
  • Chest x-ray
  • Blood tests
  • An echocardiogram to check for diastolic dysfunction
  • Exercise test
  • Heart catheterization

Treatment

There is no specific treatment for diastolic heart failure. But some treatments can use to ease the symptoms and improves the way for heart pumps.  Your doctor may also suggest some medication like

  • Diuretics: which will help to ease edema (Swelling)
  • Antihypertensive drugs
  • mineralocorticoids

Prevention of diastolic heart failure

Given the high rates of morbidity and mortality in older patients with established Heart Failure, prevention of this disorder is clearly desirable. At the present time, the best preventive measures include aggressive treatment of hypertension and other known coronary risk factors. Indeed, based on data from the Systolic Hypertension in the Elderly Program (SHEP), treatment of hypertension may reduce the risk of incident HF by as much as 50% during a 5-yr follow up period, and the benefit is most pronounced in patients 80 yr of age or older

Your doctor may also suggest lifestyle changes:

Dr Aadarsh Yadav

Dr Adarsh Yadav is a registered medical expert currently is a medical officer at the department of paediatrics at Scheer memorial Adventist hospital, kavre, Nepal. He had been a very well trained medical practitioner, and apart from his medical practice, he had been a member of different health camps organizing blood donation camps in Bangladesh just during his internship.

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