Diastolic dysfunction and heart failure are distinct cardiac conditions that can be related. This article clarifies their differences and connections, explaining how they impact the heart and body.
Understanding Diastolic Dysfunction
Diastolic dysfunction refers to a problem with the heart’s ability to relax and fill with blood during the diastole phase of the cardiac cycle. When diastolic dysfunction occurs, the heart muscle becomes stiff, preventing the ventricles from fully expanding and filling with the necessary volume of blood. This reduced filling can lead to pressure buildup within the heart chambers.
Several factors can contribute to diastolic dysfunction. Advancing age is a common cause, as heart muscle fibers can become less elastic over time. Conditions like high blood pressure (hypertension) can cause the heart muscle to thicken, making it stiffer and less able to relax properly. Diabetes, coronary artery disease, and sleep apnea are also recognized risk factors.
Understanding Heart Failure
Heart failure is a condition where the heart cannot pump enough blood to meet the body’s demands for oxygen and nutrients. This means that its pumping action is insufficient. Heart failure can affect either the left or right side, or both. When the left side is affected, fluid can back up into the lungs, causing shortness of breath.
Heart failure is categorized into two main types: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). HFrEF occurs when the left ventricle cannot squeeze strongly enough to pump blood effectively. HFpEF, also known as diastolic heart failure, happens when the left ventricle is stiff and cannot relax or fill properly, even though its pumping strength may be normal. Symptoms include shortness of breath, fatigue, and swelling in the legs, ankles, or feet due to fluid buildup.
The Connection Between Diastolic Dysfunction and Heart Failure
While distinct, diastolic dysfunction and heart failure are often related, particularly the HFpEF type. Diastolic dysfunction is an abnormality in the heart’s mechanical function during the filling phase. It can exist independently or serve as a precursor to heart failure. Many individuals have mild diastolic dysfunction without experiencing heart failure symptoms.
When impaired diastolic function leads to increased pressures within the heart chambers and lungs, it can result in heart failure symptoms. This progression is observed in HFpEF, where the stiffened ventricle’s inability to fill adequately causes blood to back up, leading to shortness of breath and fluid retention. This condition indicates a risk for developing symptomatic heart failure, especially if underlying risk factors are not addressed.
Diastolic dysfunction is a key component in the diagnosis of HFpEF. HFpEF is a clinical syndrome characterized by heart failure symptoms and signs with a preserved ejection fraction, while diastolic dysfunction describes the underlying mechanical problem. Therefore, all patients with HFpEF have diastolic dysfunction, but not all individuals with diastolic dysfunction will develop symptomatic HFpEF.
Diagnosis and Management Approaches
Diagnosing both diastolic dysfunction and heart failure often involves a medical evaluation. Echocardiography, an ultrasound of the heart, is a primary tool used to assess how well the heart’s chambers relax and fill. This imaging technique can indicate the severity of diastolic dysfunction by measuring various parameters. Blood tests, including natriuretic peptides, can also aid in evaluating suspected heart failure.
Management for diastolic dysfunction focuses on controlling underlying conditions. This includes managing high blood pressure, diabetes, and coronary artery disease. Lifestyle modifications are also important, such as maintaining a healthy weight, adopting a balanced diet low in sodium, and engaging in regular physical activity. These measures can help prevent the progression of diastolic dysfunction to symptomatic heart failure.
For heart failure with preserved ejection fraction (HFpEF), management aims to alleviate symptoms and improve quality of life. Diuretics, often called water pills, are commonly used to reduce fluid buildup and alleviate congestion symptoms. Newer medications, such as SGLT2 inhibitors, have also shown benefit in improving outcomes for patients with HFpEF. Controlling heart rate and addressing co-existing conditions like atrial fibrillation are also important in managing HFpEF.