Diastolic Dysfunction: Everything You Need to Know

Diastolic dysfunction is a heart condition that happens when there is a “stiffening” of the major pumping chambers of the organ (ventricles). This stiffness gets in the way of the heart’s ability to fill up with blood between heartbeats. 

This article will go over what diastolic dysfunction is, who gets it, how it’s diagnosed, and how it can be treated and prevented. 

What Is Diastolic Dysfunction?

Diastolic dysfunction is when the heart’s ventricles abnormally stiffen, which prevents the ventricles from relaxing as they should and prevents them from filling up. This disrupts the flow of blood to and from the organs of the body.

It will help to know how the cardiac cycle works if you want to understand how having diastolic dysfunction can affect your body.

The two parts of the cardiac cycle are systole and diastole:

• During systole, the ventricles contract, which causes blood to go out of the heart and into the arteries. 
• During diastole, the ventricles stop contracting and relax; they fill up with blood to prepare for the next systole.

How Does Diastolic Dysfunction Affect the Body?

The incomplete filling of the heart's ventricles means that less blood will get pumped out in the next heartbeat. The blood that’s returning to the heart can "dam up" inside the organs.

The backup can cause fluid to collect in the lungs, which can make a person feel short of breath. It can also cause the blood pressure in the lungs to get very high (pulmonary hypertension).

If the fluid pools in the legs or abdomen, it can cause swelling (edema). Some people will also feel more tired (fatigued) than usual.

What Is Diastolic Heart Failure?

Diastolic heart failure is when diastolic dysfunction gets so bad that a person starts having symptoms of heart failure.

At first, diastolic dysfunction may not cause symptoms. However, diastolic dysfunction tends to get worse over time. When the condition is severe enough to cause congestion in the lungs or swelling in the legs, a person has diastolic heart failure.

In general, when providers use the terms “diastolic dysfunction” and “diastolic heart failure,” they mean that there is diastolic dysfunction but no signs of systolic dysfunction. 

In recent years, some cardiologists have started calling diastolic heart failure “heart failure with preserved ejection fraction (HFpEF)."

The term "preserved ejection fraction" means that even though a person's heart is not filling properly because it's too stiff, it's still pumping normally. On the other hand, if the heart is too stiff to fill and it's not pumping normally, a person may have heart failure with "reduced ejection fraction."

Who Gets Diastolic Dysfunction?

Diastolic dysfunction is common, especially in people over 45 years of age. However, many people are shocked to find out they have a heart problem because they haven't had symptoms.

People with diastolic dysfunction and diastolic heart failure are likely to: 

• Be over the age of 45
• Be overweight or have obesity
• Have high blood pressure (hypertension)
• Be female
• Have no history of heart attacks

The risk of developing diastolic dysfunction appears to be the same in men and women, but older men who have obesity and hypertension are more likely to have heart attacks than women of around the same age. Their heart failure is also more likely to be “standard” congestive heart failure than diastolic heart failure.

While people have probably always had these conditions, it’s only been in the past few decades that providers have had technology like echocardiography to help them diagnose diastolic dysfunction and diastolic heart failure. Therefore, they are kind of seen as “new” cardiac diagnoses. 

Even though some people with diastolic dysfunction condition do develop diastolic heart failure, many will not—especially if they get medical care and take steps to improve their health. That said, diastolic heart failure is also diagnosed often; almost half the patients who come to the ER with acute heart failure turn out to have diastolic heart failure.

What Causes Diastolic Dysfunction?

Several conditions seem to contribute to diastolic stiffening of the heart including:

• High blood pressure
• Hypertrophic cardiomyopathy
• Aortic stenosis
• Coronary artery disease
• Restrictive cardiomyopathy
• Diabetes
• Obesity
• Sleep-disordered breathing

While your risk of developing diastolic dysfunction increases with age, it’s not clear whether age itself causes stiffening of the ventricles or if the stiffening is related to other medical conditions that happen as you get older.

Symptoms

People with diastolic dysfunction usually have no obvious symptoms. However, they may notice a gradual decrease in their ability to exercise (which they often think is just because they’re getting older or carrying some extra weight). 

Once diastolic heart failure sets in, the main symptom is shortness of breath (dyspnea). Feeling short of breath is also common in congestive heart failure; however, with congestive heart failure, symptoms typically build up over hours or days. 

The shortness of breath with diastolic heart failure is more likely to come on suddenly and can be very severe when it happens. 

These episodes are commonly called “flash pulmonary edema.”

Diagnosis

Diastolic dysfunction and heart failure are diagnosed with a test called echocardiography.

Here's what the test can tell providers about a patient's heart function:

• In people with diastolic dysfunction, the echocardiogram is checked for characteristics of diastolic relaxation (stiffness). 
• In people with diastolic heart failure, an echocardiogram will show diastolic stiffness and normal pumping (systolic) heart function. Specifically, the left ventricular ejection fraction is normal in a person with heart failure.

Grading

There are four grades of diastolic heart dysfunction that a provider can diagnose based on how severe the condition is:

• Grade I: Slightly impaired diastole
• Grade II: Elevated pressure in the left side of the heart
• Grade III: Very elevated pressure in the left side of the heart
• Grade IV: Advanced heart failure and very elevated pressure on the left side of the heart

Treatment

Treating diastolic dysfunction is really about treating the underlying causes. Losing weight, exercising, managing blood pressure, keeping diabetes under control, and addressing any risk factors for coronary artery disease can all improve a person’s cardiac diastolic function.

Treating diastolic heart failure can be challenging because many of the medications that are effective for congestive heart failure do not help with diastolic dysfunction. 

If a person has acute pulmonary edema, diuretics (such as Lasix) are the usual treatment. 

Lifestyle changes and aggressive treatment of high blood pressure and diabetes are helpful in preventing recurrent episodes of heart failure. 

If a person has atrial fibrillation (afib), it is important to take steps to prevent the arrhythmia from happening again because it can trigger worse heart function (cardiac decompensation) in people with diastolic heart failure.

For some people with diastolic heart failure, medications such as SGLT2 inhibitors, aldosterone antagonists, angiotensin II receptor blockers (ARBs), and angiotensin-receptor neprilysin inhibitors (ARNIs) are recommended.

Prevention

You don’t have control over all the factors that can increase your risk for heart disease, like your age and genetics. 

However, there are some steps you can take to keep your heart healthy and possibly prevent or at least manage diastolic dysfunction:

• Eat a balanced, nutritious diet and follow any specific recommendations your provider gives you (e.g., limiting your salt intake) 
• Stay hydrated 
• Exercise regularly (as long as your provider says that it’s safe for you)
• Lose weight if you need to and maintain a weight that supports your health
• Make sure you’re getting enough quality sleep
• Stick to the treatment plan your provider has given you, which includes taking any medications as prescribed and keeping up with your medical appointments
• Find activities that you enjoy that help you manage stress

 Summary

Diastolic dysfunction happens when the ventricles in the heart get stiff and don’t work as well. Over time, it can lead to heart failure. 

Making your health a priority and taking steps to treat any chronic conditions you have (like high blood pressure and obesity) can help you manage diastolic dysfunction and prevent heart disease from getting worse. 

Heart Failure Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Download PDF

Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.

Sign Up

You're in!

Thank you, {{form.email}}, for signing up.

There was an error. Please try again.