Home Cardiovascular Disease Diagnosis & Treatment of Diastolic Heart Failure

Diagnosis & Treatment of Diastolic Heart Failure

How is diastolic heart failure diagnosed?

The main difference between diastolic heart failure and systolic heart failure is that the heart of a patient with diastolic heart failure has a normal ability to pump out blood. This is measured by ejection fraction, the percentage of blood pumped—or "ejected"—out of a filled pumping chamber ( ventricle) during each heartbeat.

To measure your ejection fraction, your doctor will order a Doppler echocardiogram to check the size of your main pumping chamber and determine if it is pumping out blood as it should. Diastolic heart failure usually has a normal ejection fraction of 50% or higher because the main pumping chamber is still pumping half or more of the blood it holds. However, the heart still pumps out less blood than normal because it is unable to relax and fill with enough blood. Women are more likely than men to have a high ejection fraction.27

You will be diagnosed with diastolic heart failure if your doctor finds you have signs and symptoms of heart failure, especially the backup and buildup of fluid (congestion) in the lungs, normal ejection fraction, and blood-filling problems caused by pumping chambers that have become too stiff to relax and fill with enough blood.10, 28

How is diastolic heart failure treated?

Diastolic heart failure has been less studied and understood than systolic heart failure. Although research on the conditions is progressing, the treatment of diastolic heart failure remains less well established than the treatment of systolic heart failure because there are only a few, small clinical trials on treating this type of heart failure. Therefore, many of the medications used to treat systolic heart failure are used to treat diastolic heart failure, focusing on reducing symptoms (such as fluid buildup) and controlling or treating the underlying cause.

The backup and buildup of fluid in the lungs and body can be controlled with diuretics.10 If your diastolic heart failure was caused by uncontrolled high blood pressure, your doctor can use angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to normalize your blood pressure and reverse some of the ventricular thickening and impaired relaxation.10, 29 Beta-blockers, digoxin, and some calcium channel blockers may be used to slow a rapid heart rate ( tachycardia). Slowing your heart rate allows your heart's pumping chambers more time to relax and fill with blood.10

Is the outcome better with diastolic heart failure than with systolic heart failure?

Heart failure is a serious, potentially life-threatening condition, especially for those with more severe symptoms.30 Research regarding the outcome of diastolic heart failure compared with systolic heart failure varies greatly. Earlier studies reported a better outcome for people with diastolic heart failure,9, 31, 33 but more recent studies indicated that both forms of heart failure are equally serious and have similar prognosis.4, 32 Women with diastolic heart failure have a better chance of survival than men.34-35

It was thought that diastolic heart failure patients had a somewhat better outcome than those with systolic heart failure, from a yearly chance of death of 5% to 8% for diastolic heart failure compared with 10% to 15% for systolic heart failure.9 More recent studies, however, have found that diastolic heart failure can be almost as lethal as systolic heart failure, with about 30% dying in the first year and an additional 30% dying in the next four years.4, 32 These studies did not report results in women separately.

References

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