Diastolic dysfunction is a condition where the heart’s lower chambers, known as ventricles, have difficulty relaxing and filling with blood during the resting phase between beats. This impairment means the ventricles cannot adequately fill, making it a common underlying factor in heart failure, especially prevalent among older adults.
Understanding Diastolic Dysfunction
The heart muscle becomes stiff, hindering the ventricles’ ability to relax and fill efficiently after each contraction. This stiffness can cause blood to back up, leading to increased pressure within the heart chambers, lungs, and other body parts. Fluid accumulation may cause symptoms such as shortness of breath and swelling. Conditions like high blood pressure, diabetes, obesity, and coronary artery disease are frequently associated with its development.
Medications for Symptom Relief
Medications for symptom relief primarily address fluid overload, a common consequence of diastolic dysfunction. Diuretics, such as furosemide or hydrochlorothiazide, are often prescribed. They increase the excretion of sodium and water through the kidneys, reducing excess fluid buildup. By eliminating this fluid, diuretics alleviate symptoms like swelling in the legs and abdomen, and reduce shortness of breath.
While diuretics offer relief by reducing volume overload, they do not directly improve the heart’s stiffness or its ability to relax. They are used at the lowest effective dose to maintain a balanced fluid state and are part of a broader treatment plan.
Medications to Improve Heart Filling
Certain medications target the heart’s ability to relax and fill more effectively. Beta-blockers, including metoprolol and carvedilol, slow the heart rate, allowing more time for the ventricles to relax and fill completely during diastole. By extending the filling phase, beta-blockers improve the overall efficiency of blood flow.
Calcium channel blockers, such as verapamil and diltiazem, also enhance heart relaxation. These medications directly promote the relaxation of heart muscle cells, reducing stiffness and allowing for better ventricular filling. Both beta-blockers and certain calcium channel blockers are important for addressing impaired relaxation, optimizing the heart’s performance by improving its ability to accept blood between beats.
Medications for Long-Term Heart Health
For long-term heart health in diastolic dysfunction, particularly in heart failure with preserved ejection fraction (HFpEF), several medication classes are used to address underlying causes and disease progression.
ACE Inhibitors and ARBs
Angiotensin-converting enzyme (ACE) inhibitors, like lisinopril, and Angiotensin Receptor Blockers (ARBs), such as valsartan, block pathways that contribute to blood pressure elevation and adverse heart remodeling. These actions help reduce the heart’s workload and can improve outcomes over time.
Mineralocorticoid Receptor Antagonists (MRAs)
Mineralocorticoid Receptor Antagonists (MRAs), including spironolactone and eplerenone, are an important class. These medications counter hormones that can lead to fluid retention and fibrosis in the heart, contributing to improved heart function and reduced hospitalizations in HFpEF patients.
SGLT2 Inhibitors
More recently, SGLT2 inhibitors, such as dapagliflozin and empagliflozin, have shown significant promise for improving outcomes in HFpEF. These drugs, initially for diabetes, offer benefits by promoting fluid excretion, reducing cardiac hypertrophy, and improving diastolic function.
These therapies collectively target mechanisms contributing to heart stiffness and fluid imbalances, supporting long-term heart health.
Guiding Principles of Treatment
Treatment for diastolic dysfunction is highly customized, requiring close management by a healthcare professional. A comprehensive approach involves addressing underlying conditions like high blood pressure, diabetes, and obesity. Medication regimens are often multimodal, combining different drug classes to manage symptoms and improve heart function. Regular monitoring of the patient’s response and adjustments to dosages are routinely performed. Consulting a doctor for an accurate diagnosis and a personalized treatment plan is always recommended.