Treating Diastolic Dysfunction and Diastolic Heart Failure

Diastolic dysfunction refers to a cardiac condition caused by a “stiffening” of the heart’s ventricles, which restricts the heart’s ability to fill up with blood in between beats. Diastolic heart failure is said to be present when diastolic dysfunction has progressed sufficiently to produce symptoms of heart failure.

The primary goals of treatment for these cardiac conditions are stopping the progression of the disease, relieving symptoms, and lowering the risk of deaths. These are largely achieved by addressing underlying conditions that contribute to the condition, such as diabetes, hypertension (high blood pressure), coronary artery disease, and atrial fibrillation, among others. Depending on the individual and their particular situation, treatment therefore can include a combination of lifestyle modifications, prescription medications, or medical procedures such as angioplasty or bypass surgery.

Lifestyle Management

Even for people with diastolic dysfunction who take medication, lifestyle modifications are of paramount importance to managing the condition and preventing it from becoming worse.

Weight Loss

Excess body weight forces the heart to work harder than it should. It also can contribute to type 2 diabetes, which, along with being overweight or obese, can contribute to cardiac complications and diseases.

For most people, it doesn't take a dramatic dip in body weight to help treat diastolic dysfunction or mitigate the effects of diabetes on heart health. For example, in studies of people with obesity and heart failure, a loss equal to or more than just 5% of body weight was associated with a significant decrease in mortality. This might mean, for example, that someone with diastolic heart failure who weighs 200 pounds could potentially live longer by losing just 10 pounds.

Exercise

It's been known for some time that regular, moderate aerobic exercise can improve the diastolic function of the heart. This doesn't mean it's necessary to become a marathon runner. Aerobic exercise refers to any activity that raises the heart rate enough to help strengthen the heart muscle, which can include swimming, bicycling, and brisk walking.

The amount of exercise associated with improved heart health and function may also surprise you.

Exercise in the form of a cardiac rehabilitation program is the only approach to managing diastolic dysfunction that has been clinically proven in studies to significantly improve quality of life.

Following a Heart-Healthy Diet

If you have diastolic dysfunction, simple changes in what you eat each day can play a significant role in preventing the condition from progressing. The AHA lays out simple guidelines for choosing foods that can help improve your heart health.

The Mediterranean Diet is an example of an effective approach to eating that embraces the AHA's recommendations and is easy to follow and stick with. It is based on the eating habits of people in countries of the Mediterranean region, especially Greece. There is research to show the Mediterranean diet may help reduce the risk of heart disease, cancer, diabetes, and other health concerns.

The AHA also advises limiting caffeine to no more than one to two cups per day.

Low-Sodium Diet

Lowering sodium intake is an especially important aspect of any heart-healthy diet, since as many as 50% of people who have diastolic dysfunction also have hypertension. Bringing elevated blood pressure down to normal levels can help to prevent diastolic dysfunction from progressing to heart failure.

The limitations on sodium in the Mediterranean diet are likely sufficient to help accomplish this, but there also is a specific diet plan for tackling high blood pressure. Known as the DASH diet, it was developed by the National Institutes of Health and is based on limiting sodium intake to 2,300 milligrams or 1,500 milligrams per day, as well as lowering overall dietary fat.

Like the Mediterranean diet, the DASH diet emphasizes the importance of eating fruits and vegetables, whole grains, fish, poultry, legumes, and low- or non-fat dairy products every day.

Quitting Smoking

If you smoke, according to the AHA, every time you take a drag on a cigarette your heart rate speeds up and your blood pressure is elevated temporarily. At the same time, less oxygen-rich blood is flowing through your body. In addition, over time, smoking can cause "stickiness" in blood vessels, effectively slowing and diminishing blood flow.

There are many effective ways to kick the habit, from quitting cold turkey to relying on support from self-help groups or taking medication. Whichever approach works for you, as soon as you put out that final cigarette, your cardiovascular system will begin to heal.

Limiting Alcohol

Many people with diastolic dysfunction and other heart conditions are able to drink alcohol—as long as they do so in moderation. This is defined by the AHA as:

• For men, no more than one to two drinks per day
• For women, no more than one drink per day

A drink equals:

• 12 ounces of regular beer
• 5 ounces of wine
• 1.5 ounces of 80-proof spirits, such as bourbon, vodka, or gin

Controlling Hypertension

Hypertension is a major underlying cause of diastolic dysfunction. If you have high blood pressure, you can help lower it by exercising regularly, eating a heart-healthy diet, and making other simple lifestyle changes. If such changes are not enough to reduce blood pressure, you may need to take medication as well.

Prescriptions

Treating diastolic dysfunction can be a challenge. There are no medications that treat diastolic heart failure, with the possible exception of the diuretic drug spironolactone. That's why the best approach is to treat the underlying issues that are causing diastolic heart failure (e.g., smoking, hypertension, coronary disease, obesity, etc.). For the most part, drugs prescribed for people with diastolic dysfunction are used not to directly treat the condition, but rather to mitigate symptoms.

Diuretics

In addition to dietary changes, high blood pressure can be treated with medications called diuretics. These drugs have been shown to effectively help manage diastolic heart failure by removing excess sodium and fluid from the body.

For example, a 2014 study called the TOPCAT trial found spironolactone (CaroSpir, Aldactone) reduced the risk of hospitalization in people with diastolic heart failure. (The drug did not, however, lower the rate of death due to diastolic heart failure).

There are three classes of diuretics, each of which affects blood pressure differently (both directly and indirectly).

ACE (Angiotensin-Converting Enzyme) Inhibitors

These oral medications work by widening blood vessels, allowing for an increase in blood flow. As a result, they lower blood pressure and ease the workload on the heart. Ace inhibitors are effective at improving diastolic function and are recommended as first-line drugs to control hypertension in patients with diastolic heart failure.

There are many ACE inhibitors available in the United States, among them:

• Capoten (captopril)
• Prinivil and Zestril (lisinopril)
• Vasotec (enalapril)
• Altace (ramipril)
• Accupril (quinapril)
• Monopril (fosinopril)
• Mavik (trandolapril)
• Aceon (perindopril)

Calcium Channel Blockers

Calcium channel blockers work by reducing the amount of calcium that flows into cells in the heart as well as the walls of arteries, causing blood vessels to relax and increasing and easing blood flow.

Calcium channel blockers often prescribed for hypertension are:

• Calan, Verelan (verapamil)
• Norvasc (amlodipine)
• Tiazac, Cardizem, Dilacor (diltiazem)
• Procardia (nifedipine)
• Cardene (nicardipine)
• Lotrel (amlodipine and benazepril)
• Caduet (amlodipine and atorvastatin
• Exforge (amlodipine and valsartan)

SGLT2 Inhibitors

Jardiance (empagliflozin) is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, which was initially prescribed to lower blood sugar and reduce the risk of cardiovascular death in adults with type 2 diabetes. However, it is now approved and recommended for adults with heart failure (regardless of ejection fraction) to reduce the risk of cardiovascular death and hospitalization due to heart and blood vessel disease. 

It's still unclear how exactly this medication treats heart failure, though researchers believe it may work by making it easier for the heart to pump blood throughout the body.

Angiotensin II Receptor Blockers (ARBs)

ARBs work by lowering blood pressure, which helps reduce the strain on the heart. They are similar to ACE inhibitors and are equally effective in lowering blood pressure, but have fewer side effects. An ARB may be considered for some people to help decrease hospitalizations.

Examples include:

• Atacand (candesartan)
• Cozaar (losartan)
• Diovan (valsartan)

Angiotensin-Receptor Neprilysin Inhibitors (ARNIs)

Entresto contains a combination of valsartan (an ARB inhibitor) and a new type of drug called sacubitril. Sacubitril is a neprilysin inhibitor, which causes an increase in levels of natriuretic peptides. This helps regulate blood pressure, along with salt and fluid levels.

Sleep Apnea Treatment

Sleep apnea conditions are common among people with diastolic dysfunction. The most effective treatment for sleep apnea is a continuous positive airway pressure (CPAP) device. The CPAP mask fits over the nose and mouth and gently blows air into the airway to help keep it open during sleep.

Although it's possible in some cases to purchase a CPAP machine over the counter, most often a prescription is required. In fact, this is ideal, because it means how the apparatus is used can be fine-tuned to meet a person's specific needs. It's also more likely insurance will cover a healthcare provider-prescribed CPAP machine.

Surgeries and Specialist-Driven Procedures

Diastolic dysfunction that does respond to lifestyle changes and medication may require more aggressive—and sometimes invasive—treatment.

Cardioversion

Atrial fibrillation (AFib)—an abnormally fast and irregular heartbeat—is a common characteristic of diastolic dysfunction, and one that can cause heart palpitations, shortness of breath, and a tendency to become easily fatigued. More concerning, however, is that uncontrolled AFib in people with heart disease can lead to worsening heart failure.

Cardioversion refers to any treatment targeted at bringing AFib under control. In acute cases, some medications can be used to do this, including Tambocor (flecainide), Corvert (ibutilide), Rhythmol (propafenone), and Tikosyn (dofetilide). However, most of these only work 50% to 60% of the time and can cause side effects.

For these reasons, most cardiologists prefer electrical cardioversion, which involves being placed into a light, anesthesia-induced sleep for a few minutes, during which time a quick and painless electrical discharge is administered to the chest with a set of paddles. The procedure is safe and almost always works.

Angioplasty

This minimally invasive surgical procedure is performed to widen blood vessels blocked by atherosclerotic plaque. It involves threading a long, thin, flexible tube called a catheter across the plaque and then inflating a balloon attached to the catheter to widen the artery wall.

If necessary a mesh, tube-shaped device called a stent is left behind to serve as a "scaffold" to help support the wall of the artery and keep it open.

Bypass Surgery

Also referred to as a heart bypass, this is an open-heart procedure in which one or more blood vessels from other parts of the body are used to replace arteries to the heart that are too clogged to be unblocked. The replacement vessels reroute blood that otherwise would not be able to flow freely.

Depending on the extent of the problem, up to four blood arteries may be bypassed. If one is involved, the procedure is called a single bypass; if two are involved, it's a double bypass; and if three or four are involved, the surgery is called a triple or quadruple bypass.

It can take up to six months to fully recover from bypass surgery, regardless of how many blood vessels are involved. In order to facilitate recovery and to prevent further problems, it's important to incorporate the lifestyle changes described above.

Heart Failure Doctor Discussion Guide

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A Word From Verywell

Diastolic dysfunction is a potentially serious diagnosis, but there are many ways in which you can prevent the condition from progressing or causing symptoms that affect your ability to function. Tweaks to your diet, an increase in your activity level, quitting smoking (if you use tobacco), and cutting back on alcohol if your intake is beyond moderate are all straightforward and effective changes that are within your control. These lifestyle modifications are guaranteed to lower your risk of other chronic conditions. Even if you need medication or a surgical procedure, continuing to watch your diet, exercising, and making other healthy changes will allow you to feel better overall and enjoy living your best life.