Treating Diastolic Dysfunction and Diastolic Heart Failure

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

Also Known As

Clinicians use the preferred term heart failure with preserved ejection fraction (HFpEF) to refer to diastolic dysfunction, according to the American Heart Association (AHA). The condition also is sometimes is called diastolic heart failure.

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

Lifestyle Management

Even for people with diastolic dysfunction who take medication, lifestyle modifications are paramount 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 increase in mortality. This might mean, for example, that potentially, someone with diastolic heart failure who weighs 200 pounds could 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 also is manageable.

The federal guidelines for aerobic exercise recommend adults log at least 150 hours of moderate activity per week to improved and maintain heart health. To lose weight the guidelines advise getting twice that—300 hours.

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

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

Emphasize
  • A variety of fruits and vegetables

  • Whole grains

  • Low-fat dairy foods

  • Skinless poultry

  • Fish and seafood

  • Nuts

  • Legumes

  • Olive, avocado, and other non-tropical vegetable oils

Limit
  • Saturated fat

  • Trans fat

  • Cholesterol

  • Sodium

  • Red meat

  • Foods such as baked goods, candy, and others sweetened with sugar

  • Soda and other beverages sweetened with sugar

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 advised 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: 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 

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 underscores the importance of deating 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 the blood vessels that lead to the heart, 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.

Within the first 24 hours of quitting cigarettes, your heart rate, blood pressure, and circulation will improve and your risk of a heart attack will begin a downward decline. After a year of not smoking, your risk of having a heart attack will be lessened by half.

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

If you have any form of heart disease, it is imperative to discuss whether it's safe for you to drink alcohol with your doctor. If you get the OK, stick with any limits on drinking they advise.

Prescriptions

Treating diastolic dysfunction can be a challenge. Because the ventricles involved in diastolic heart failure are small and stiff (rather than dilated and flaccid), many of the drugs commonly used to treat classic heart failure have the potential of actually worsening diastolic heart failure. 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 the diuretic drug Aldactone (spironolactone) 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 effects blood pressure differently (both directly and indirectly).

Types of Diuretics
Thiazides Loop Potassium-Sparing
Hydrochlorothiazide Lasix (furosemide) Aldactone
Indapamide Bumex (bumetanide) Spironolactone
Chlorothiazide Demadex (torsemide) Amiloride
Metolazone Edecrin (ethacrynic acid) Triamterene
Chlorthalidone    

ACE (angiotensin-covering enzyme) inhibitors

These oral medications work by widening blood vessels, allowing for an increase in blood flow, and as a result, lowering blood pressure and easing 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)
  • Lotensin (benazepril)
  • Altace (ramipril)
  • Accupril (quinapril)
  • Monopril (fosinopril)
  • Mavik (trandolapril)
  • Aceon (perindopril)
  • Univasc (moexipril)

Beta Blockers

Beta blockers are linked to a reduced risk of hospitalization for heart failure in patients with diastolic dysfunction and stable CHD. They work by blocking the effect of epinephrine (adrenaline) which in turn slows heart rate, reduces the force of contraction of the heart muscle, reduces how much oxygen the heart needs, reduces stress on the vascular system, and tends to lower blood pressure.

Beta blockers are oral medications. The most common ones include:

  • Sectral (acebutolol)
  • Tenormin (atenolol)
  • Kerlone (betaxolol)
  • Zebeta, also sold as Ziac (bisoprolol)
  • Cartrol (carteolol)
  • Coreg (carvedilol)
  • Normodyne, also sold as Trandate (labetalol)
  • Lopressor, also sold as Toprol (metoprolol)
  • Corgard (nadolol)
  • Levatol (penbutolol)
  • Inderal,Inderal LA (propranolol)
  • Blocadren (timolol)

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

People with type 2 diabetes are two to four times more likely to develop heart failure than someone without diabetes, according to the American Heart Association. These drugs allow the kidneys to dispose of excess blood glucose in the urine. Clinical studies of people with type 2 diabetes have shown that these medications can safely and effectively lower blood glucose levels and improve glycemic control.

There are four SGLT2 inhibitors approved by the Food and Drug Administration:

  • Invokana (canagliflozin)
  • Farxiga (dapagliflozin)
  • Jardiance (empagliflozin)
  • Steglatro (ertugliflozin)

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.

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 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.

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 doctor-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, 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), most 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.

Also Known As

Angioplasty is sometimes referred to as percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI).

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; 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 detailed above.

Heart Failure Doctor Discussion Guide

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

Doctor Discussion Guide Old Man

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 so forth will allow you to feel better overall and enjoy living your best life.

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