Diastolic heart failure occurs when the lower left chamber of the heart, known as the left ventricle, is unable to fill with blood during the diastolic phase (when the heart relaxes and fills with blood). This reduces the amount of blood pumped out to the body. If the left ventricle muscle becomes stiff or thickened, diastolic heart failure is the result. In this case, the heart must increase the pressure inside the ventricle to fill it with enough blood. Prolonged behavior like this causes blood to build up inside the left atrium and then the lungs. This leads to fluid congestion and heart failure symptoms.
Prevalence of diastolic heart failure
Diastolic heart failure is, unfortunately, more common than cardiologists previously believed. Echocardiographic studies have found the condition in 15 percent of participants under 50 years old, and in about 50 percent of people over the age of 70. It is largely a disorder for women, as up to 75 percent of those diagnosed are female. The failure is diagnosed when someone with diastolic dysfunction develops an episode of pulmonary congestion severe enough to present symptoms. If diastolic heart failure occurs once, the chances of it happening again are extremely high.
Causes, risk factors, and symptoms of diastolic heart failure
The causes of diastolic heart failure development include coronary heart disease, diabetes, high blood pressure, and obesity/inactivity. The most common cause of diastolic dysfunction and failure is chronic hypertension. This leads to left ventricular hypertrophy, which decreases cardiac compliance. Chronic hypertension also leads to increased connective tissue content.
There are several risk factors that could contribute to the condition, including the following:
- Aging: With age, the heart muscle begins to stiffen, preventing it from properly filling with blood.
- Hypertrophic cardiomyopathy: This abnormality of the heart muscle is inherited and causes the walls of the left ventricle to thicken.
- Aortic stenosis: When the opening of the aortic valve is narrowed, the left ventricle can thicken.
- Pericardial disease: This abnormality in the sac around the heart leads to fluid buildup in the pericardial space.
Diastole is when the heart returns to its relaxed state. In this condition, changes in pressure-volume of the heart lead to symptoms of diastolic heart failure. It is a complex process that is affected by factors such as heart rate, velocity of relaxation, cardiac compliance, hypertrophy, segmental wall coordination of the heart muscle, and more.
The relaxation process has four phases specialists can identify:
- Isovolumetric relaxation from the time of aortic valve closure to mitral valve opening
- Early rapid filling after mitral valve opening
- Diastasis, a period of low flow during mid-diastole
- Late filing of the ventricles from atrial contraction
The challenge with early diagnosis of this condition is that diastolic dysfunction itself produces no symptoms. If anything, a gradually progressive decrease in exercise tolerance may be a warning sign. Many people with diastolic dysfunction do not even notice that symptom, especially if they live relative sedentary lives. However, severe breathlessness (dyspnea) accompanied by coughing and hyperventilation is the typical manifestation of this condition. Additionally, symptoms may be experienced in discrete episodes, which may occur randomly and without any warning. When diastolic heart failure does set in, significant symptoms are present.
Symptoms and signs of heart failure include the following:
- Shortness of breath
- Tiredness and weakness
- Swollen feet, ankles, legs, abdomen
- Lasting wheezing or coughing
- Irregular or fast heartbeat
- Confusion and dizziness
- Needing to pee more often at night
- Lack of appetite
Complications of diastolic heart failure
Diastolic heart failure can lead to other health complications. These include the following:
- Anemia: When the blood lacks enough healthy red blood cells or hemoglobin. This can cause weakness and fatigue.
- Atrial fibrillation: An irregular heart rhythm that can increase the risk of blood clots and stroke.
- Impaired kidney function: Common in patients with heart failure and increases the risk for heart complications, hospitalization, and death.
- Cardia cachexia: Unintentional weight loss that is life-threatening without the right supplemental nutrition.
- Leg venous stasis and ulcers: A lack of good circulation can cause the skin to thicken, change color, and appear shiny. Hair may also fall out, and ulcers may develop if you sustain an injury.
- Stroke: In cases where blood supply is decreased or cut off, the brain can be deprived of oxygen, leading to cell death.
How to diagnose diastolic heart failure
To diagnose heart failure, patients are asked questions about their medical history and undergo a physical exam. There are advanced procedures and technology involved to effectively diagnose the condition, inform treatment, and monitor the heart. Tests can include:
- Blood test: Check the levels of certain fats, cholesterol, sugar, and protein in the blood that could indicate heart problems.
- Chest X-ray: A common imaging test of the lungs, heart, and aorta.
- Echocardiogram: An ultrasound exam that uses sound waves to take moving pictures of the heart’s chambers and valves.
- Electrocardiogram (EKG): Measures the electrical activity of the heart and can help determine if parts are enlarged, overworked, or damaged.
- Electrophysiology study: Records the heart’s electrical activities and pathways. It can help find what is causing heart rhythm problems and identify the best treatment.
- Stress testing: Conducted during exercise. If a person cannot exercise, medicine is given to increase their heart rate. Used along with an EKG, the test can show changes in the heart’s rate, rhythm, or electrical activity as well as blood pressure. Exercise makes the heart work hard and beat fast while heart tests are conducted.
Diastolic heart failure treatment
As of now, there are no definitive guidelines for treating diastolic dysfunction. The condition may be present for years before any symptoms are noticeable, and by that time, the first phase of diastolic heart failure has already begun. This is why it is important to detect diastolic dysfunction early and to begin treatment before the condition worsens.
For decades, the only treatment used to manage the symptoms of diastolic heart failure was using diuretics. Diuretics are effective at reducing congestion of the heart, shifting down the pressure-volume relation. More recently, specialists are examining whether a dime-size implant is able to relieve the high pressure created by the blood backing up from the heart into the lungs.
Diastolic heart failure prevention
As with many health conditions, preventative action is vital to avoiding diastolic heart failure. According to studies, nitric oxide is shown to reduce blood pressure and prevent artery blockage and stroke. By boosting the nitric oxide levels in the body with food, preventing heart failure may be possible. The following foods are able to increase nitric oxide levels in the body:
- Dark chocolate: Raw cacao beans are full of antioxidants and increase the nitric oxide levels in the body. They help lower blood pressure and reduce inflammation. That being said, it is high in sugar and should only be consumed on occasion.
- Beets: Several studies have shown that beetroot is able to lower blood pressure, is high in antioxidants and betalains, and reduces inflammation.
- Cayenne: The warming impact of this spice can help dilate blood vessels. Using excessive amounts is not recommended, but including a sprinkling in meals can be helpful.
Here are some preventative measures you can take:
- Lower your sodium intake
- Get active with moderate exercise to boost circulation and reduce stress
- Eat a healthy diet and limit sugar, saturated fat, and cholesterol
- Get regular checkups
- Maintain a healthy weight
- Reduce your alcohol intake
- Quit smoking
- Take medications as prescribed
Prognosis and life expectancy of diastolic heart failure
The prognosis of diastolic heart failure depends on the cause, the severity of symptoms, and the degree to which other organ systems are involved. Prognosis also involves the patient’s response to medications. More research and awareness on the condition may lead to earlier identification of patients who are at risk, especially before they are at the clinical stage.
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