Heart Health Heart Failure Treating Diastolic Dysfunction and Diastolic Heart Failure By Richard N. Fogoros, MD facebook linkedin Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. Learn about our editorial process Richard N. Fogoros, MD Medically reviewed by Medically reviewed by Yasmine S. Ali, MD, MSCI on December 05, 2019 facebook twitter linkedin Yasmine Ali, MD, is board-certified in cardiology. She is an assistant clinical professor of Medicine at Vanderbilt University School of Medicine and an award-winning physician writer. Learn about our Medical Review Board Yasmine S. Ali, MD, MSCI Updated on November 10, 2020 Print Table of Contents View All Table of Contents Lifestyle Management Prescriptions Surgeries and Specialist-Driven Procedures 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. 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. The Connections Between Heart Disease, Obesity, and Weight Loss 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. What Is the Mediterranean Diet? 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. What Is the DASH Diet? 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. How to Quit Smoking for Good 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 dayFor women, no more than one drink per day A drink equals: 12 ounces of regular beer5 ounces of wine1.5 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. How Much Alcohol Can Cause Heart Problems? 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 How Treating Hypertension Can Improve Diastolic Dysfunction 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) How ACE Inhibitors Effectively Treat Heart Failure 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 benazeprilCaduet (amlodipine and atorvastatinExforge (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. How Coronary Artery Disease Is Treated 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. How Sleep Apnea Is Treated 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). What to Know About Angioplasty 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. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. 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. Was this page helpful? Thanks for your feedback! Did you know the most common forms of heart disease are largely preventable? Our guide will show you what puts you at risk, and how to take control of your heart health. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Kazik A, Wilczek K, Poloński L. Management of diastolic heart failure. Cardiol J. 2010;17(6):558-565. American Heart Association. Left-sided heart failure. May 31, 2017. Zamora E, Díez‐López C, Lupón J, et al. Weight loss in obese patients with heart failure. JAHA. 24 Mar 2016;5(3): doi:10.1161/JAHA.115.002468 National Institute of Diabetes and Digestive and Kidney Diseases. Health risks of being overweight. Feb 2015. US Department of Health and Human Services. Physical activity guidelines for americans, 2nd edition. 2018. Van Craenenbroeck E. 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Diastolic dysfunction and risk of atrial fibrillation: A mechanistic appraisal. 6 Nov 2012;Circ.;126(19):2353–2362. doi:10.1161/CIRCULATIONAHA.112.113233 American Heart Association. What is atrial fibrillation (AFib or AF)? July 31, 2016. Additional Reading American Heart Association. Lifestyle changes for heart failure. May 31, 2017. Borlaug, BA. Paulus, WJ. Heart failure with preserved ejection fraction: Pathophysiology, diagnosis, and treatment. Eur Heart J . 2011; 32:670. doi:org/10.1093/eurheartj/ehq426 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 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;28:e240–e327. doi:10.1161/CIR.0b013e31829e8776