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Diastolic heart failure is a condition in which the pumping chambers (ventricles) of the heart become thickened, grow stiff and cannot relax enough to adequately fill the heart’s lower chambers (ventricles) with blood. The fluid then backs up into organs and causes swelling (edema) (especially in feet and ankles) and congestion even though the heart's pumping function (ejection fraction) is normal. This type of heart failure is caused by conditions such as acute ischemia, systolic hypertension with enlargement of the left ventricular muscle, restrictive cardiomyopathy and hypertrophic cardiomyopathy
More than five million people in the United States have chronic heart failure. The primary symptom of chronic heart failure is the decreased ability to do daily activities like walking, vacuuming, or yard work.
The symptoms are shortness of breath or fatigue. It can be associated with:
- Chest discomfort
- Leg swelling
- Difficulty breathing at night
Patients develop these symptoms slowly, over years, thinking they are just getting older, and start to do less and less activity. Many things can cause these symptoms and a detailed history and physical exam, supplemented by certain tests, can help make the diagnosis. Patients with heart failure typically have either a low or a normal ejection fraction. Ejection fraction is a measure of how much blood the heart pumps out with each beat, and is indicated as percentage. A normal ejection fraction is more than 50 percent.
Half of those suffering from heart failure have a “normal” ejection fraction. Although the ejection fraction is normal and the heart can pump well, it does not relax well causing the pressure in the heart to increase. Increased heart pressure can cause shortness of breath and fatigue.
Patients with heart failure and a normal ejection fraction tend to be older women with long-standing high blood pressure. This type of heart failure is also common among patients who have diabetes, who experience sleep apnea (when an individual briefly stops breathing during sleep), and suffer from chronic kidney disease.
The keys to managing this type of heart failure are diagnosing it early before the condition has progressed too far, and managing other conditions that can be present. Often patients will go to the hospital emergency room with symptoms of pulmonary edema (water in the lungs) as their first indication of heart failure. When this occurs, they then are at risk of being hospitalized in the future.
Diagnostic tests such as an echocardiogram (an ultrasound of the heart), stress tests, and cardiac catheterization are helpful in determining how well the heart pumps, whether any heart valves are leaky or narrow, if the pressures are too high in the chambers, and if there is narrowing of the arteries that can reduce blood flow to the heart muscle. These and other tests help find out whether the heart is the primary cause of symptoms.
Diastolic Heart Failure or Diastolic Dysfunction refers to a decline in the performance of the left ventricle (the main squeezing chamber of the heart) during the diastole phase of the heart’s pumping cycle, usually due to stiffening of the heart muscle. Diastole is the phase when the ventricles are not squeezing to propel blood out to the body, but rather, are relaxed and filling with incoming blood.
Diastolic Heart Failure, also called Heart Failure with Preserved –or Normal– Ejection Fraction (HFPEF or HFNEF), refers to a condition in which people may have symptoms of Heart Failure (like shortness of breath, fatigue, or swelling) and still have a normal or near normal left ventricular ejection fraction (LVEF).
LVEF is the measurement of how much blood is pumped out of the left ventricle with each beat. LVEF is usually expressed as a percentage. A normal heart pumps a little more than half the left ventricle’s blood volume with each beat. A normal LVEF ranges from 50-70%. A LVEF of 65, for example, means that 65% of the total amount of blood in the left ventricle is pumped out with each beat. The LVEF may be lower when the heart muscle has become damaged due to a heart attack or other causes. An LVEF of 35% may indicate Systolic Heart Failure (not enough blood is pumped out of the left ventricle with each beat). Someone with Diastolic Heart Failure can have a normal LVEF. Among patients with Heart Failure, 40-60% have a normal or near normal LVEF.
Any condition or process that leads to stiffening of the left ventricle can lead to Diastolic Dysfunction:
- High Blood Pressure. The muscle stiffens as a result of higher pressure
- Aortic Stenosis (narrowing of the valve from the left ventricle). This would be like placing your thumb over the end of a water hose; creating a higher water pressure
- Scarred Heart Muscle (from a heart attack, due to ischemia, or muscle injury)
- Diabetes (stiffening occurs as a result of glucose/sugar binding with certain proteins in the heart muscle)
- Ventricular Dilation (the ventricle is stretched beyond capacity; as blood enters, it meets with increased resistance, making the muscle stiff
- Restrictive Cardiomyopathy (condition that “restricts” the heart from relaxing)
- Pericarditis (inflammation of the sac around the outside of the heart)
- Normal aging
- Chemotherapy for diseases like cancer
- Genetic causes
Diastolic heart failure occurs when the lower left chamber (left ventricle) is not able to fill properly with blood during the diastolic (filling) phase. The percentage of blood pumped out (ejection fraction) often is normal.
Diastolic dysfunction most often is caused by an incomplete relaxation (stiffness) of the ventricle muscle, which may develop from untreated high blood pressure.
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