Treating Diastolic Dysfunction and Diastolic Heart Failure

If you have been told you have diastolic dysfunction or diastolic heart failure, it is important for you and your doctor to work out a treatment plan, both to prevent and control your symptoms, and to reduce your chances of dying from this condition. 

The best strategy for treating diastolic dysfunction, of any level of severity, is to attempt to identify any underlying conditions that contribute to it and then aggressively manage them. In particular, the following possibilities must be addressed.

Underlying Conditions That Contribute to Diastolic Dysfunction and Diastolic Heart Failure
Verywell / Brianna Gilmartin

Causes

There are numerous factors that contribute to diastolic dysfunction, some of which work together to increase the risk or severity of the dysfunction. The most common culprits include:

Sedentary Lifestyle

Many people with diastolic dysfunction lead habitually sedentary lives, and being sedentary is a major contributing factor to diastolic heart problems. A program of aerobic exercise training can improve the diastolic function of the heart and can be very helpful in diastolic dysfunction.

A routine exercise program is the only treatment that has been shown to improve the quality of life in people with diastolic dysfunction.

You should talk to your doctor about referring you to a cardiac rehabilitation program to get started.

Atrial Fibrillation

If you have atrial fibrillation, this cardiac arrhythmia should be adequately treated. In people who have diastolic dysfunction and atrial fibrillation, the rhythm control strategy is generally preferred over the rate control strategy.

However, if a normal heart rhythm cannot be maintained, it is particularly important to get the heart rate under control This is because the rapid heart rates commonly caused by atrial fibrillation can cause significant deterioration in cardiac function in people with diastolic dysfunction. 

Hypertension

You should be carefully evaluated for hypertension. Hypertension is often present in people who have diastolic dysfunction, and it can be tricky to diagnose. Worse, hypertension is very often inadequately treated.

If you have diastolic dysfunction, your doctor needs to ensure your blood pressure is in the optimal range. If needed, high blood pressure medications and other interventions may be prescribed.

Sleep-Disordered Breathing

Breathing disorders during sleep, especially sleep apnea conditions, can contribute significantly to diastolic dysfunction. People with diastolic dysfunction—especially if they are obese or have symptoms suggestive of sleep-disordered breathing—should be evaluated for sleep apnea, and if it is diagnosed they should be treated.

The treatment of choice for sleep apnea is continuous positive airway pressure device (CPAP). CPAP is a mask that fits over the nose and/or mouth and gently blows air into the airway to help keep it open during sleep.

Coronary Artery Disease

People with diastolic dysfunction should also be evaluated for the presence of coronary artery disease (CAD); if CAD is diagnosed, it should be treated aggressively. Occult (that is, undiagnosed and asymptomatic) CAD is a common cause of diastolic dysfunction. 

Diabetes and obesity are both tied to coronary artery disease and, in turn, diastolic dysfunction. Losing weight and keeping diabetes under control can help slow the progression of diastolic dysfunction.

Treatment

Treating diastolic heart failure (which cardiologists now refer to as “heart failure with preserved ejection fraction,”) can be a challenge. In contrast to classic systolic heart failure, in which many studies have revealed specific drug treatment regimens that significantly improve mortality, no such studies are available for diastolic heart failure.

Furthermore, because the ventricles in diastolic heart failure are small and stiff (rather than dilated and flaccid), many of the drugs commonly used in classic heart failure have the potential of actually worsening diastolic heart failure.

Drug therapy for diastolic heart failure is often limited to using diuretics such as furosemide (Lasix) to reduce excess sodium and water from the body and to reduce the symptoms of pulmonary congestion and edema. Drugs for controlling hypertension are also important.

According to the results of the TOPCAT trial conducted in 2014, the diuretic drug Aldactone (spironolactone) reduced the risk for hospitalization in people with diastolic heart failure but did nothing to reduce the rate of mortality.

But the most important therapy for diastolic heart failure is to aggressively control the same factors, listed above, that are important in treating diastolic dysfunction.

Of these, exercise training (not being sedentary any longer) is the only method that has been shown in clinical studies to significantly improve the quality of life in people with diastolic heart failure. 

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Prognosis

People who have had an episode of diastolic heart failure have a serious, life-threatening cardiac condition. While their overall prognosis may be somewhat better than for patients with classic systolic heart failure, it is still substantially reduced.

This is why anyone who has had diastolic heart failure needs to be treated aggressively, by attempting to manage all of the underlying conditions associated with this diagnosis. 

Even people with diastolic dysfunction who do not have symptoms of heart failure have an increased risk of mortality, due in part to the undertreatment of hypertension and coronary artery disease.

Diastolic dysfunction is an important condition that, at the very least, should prompt a careful search for underlying causes, and then aggressive treatment. The adequate treatment of diastolic dysfunction can greatly improve the likelihood of a good outcome.

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Article Sources

  • Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2014; 370:1383.doi: 10.1056/NEJMoa1313731

  • Borlaug BA, Paulus WJ. Heart Failure with Preserved Ejection Fraction: Pathophysiology, Diagnosis, and Treatment. Eur Heart J 2011; 32:670.
  • Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62:e147.