What is diastolic heart failure?
Diastolic heart failure is a form of heart failure in which the heart’s pumping chambers have become too stiff to relax and expand to fill with enough blood. This causes the heart to pump less blood, resulting in the backup of fluid in the lungs and symptoms of heart failure. Diastolic heart failure is most common among elderly women.
Diastolic heart failure is also known as “heart failure with preserved ejection fraction” because the ejection fraction (a measure of the amount of blood pumped out of the heart during each heartbeat) is normal.
Can heart failure be cured?
Treating certain conditions that cause diastolic heart failure may stabilize the heart. You will likely have to continue to take medication even if your heart failure resolves. Even with medications, your symptoms may reoccur, and additional treatment may be needed.
In most cases, heart failure is a disease you will live with for the rest of your life, and requires close follow up with a cardiologist and your primary care doctor. Appropriate treatment can reduce your symptoms and dramatically slow the evolution of the disease, and many women go on to lead long, fulfilling lives after a diagnosis of heart failure.
How is diastolic heart failure treated?
The main goals of treating diastolic heart failure are to relieve your symptoms, improve your quality of life, and slow down the progression of heart failure by preventing further damage to your heart.
Diastolic heart failure is less understood than systolic heart failure. Although research on the condition is progressing, the treatment of diastolic heart failure remains less well established than the treatment of systolic heart failure because there are only a few small clinical trials on treating this type of heart failure.
Many of the same medications used to treat systolic heart failure are also applied to diastolic heart failure.1 Treatment focuses on:
- Getting blood pressure under control
- Slowing or reversing the thickening and stiffening of the walls of the heart’s main pumping chamber
- Preventing dangerous abnormal heart rhythms
- Treating symptoms caused by fluid buildup
- Treating the underlying disease
It is crucial that women with diastolic heart failure also receive recommended treatment for other conditions that can contribute to decreased filling ability, including coronary artery disease, high blood pressure, heart valve disease, and atrial fibrillation.
These conditions may need to be treated more aggressively in women who have diastolic heart failure. High blood pressure goals may be set lower that 130/80, which is the normal goal for women without heart failure.2 Women whose coronary artery disease is depriving the heart muscle of oxygen and contributing to the heart’s filling problems, may need to undergo a procedure to restore blood flow such as angioplasty or bypass surgery, even if they don’t have chest pain.
ACE Inhibitors and ARBs
Most women with diastolic heart failure have a history of high blood pressure. High blood pressure slows the relaxation of the heart muscle and contributes to the stiffening and thickening of the pumping chamber’s walls that make the heart less able to fill with blood.
ACE inhibitors or ARBs can lower blood pressure and reverse some of the structural changes in the heart. In women who have their blood pressure under control, these drugs can be used to relieve heart failure symptoms, and may even improve survival.
There are special considerations for patients with asthma or lung disease who are being treated with ACE inhibitors.
Beta-blockers can be used to lower blood pressure and slow down your heart rate, giving your hear more time to fill with blood. Lowering blood pressure may also help prevent further thickening of the pumping chamber walls (ventricular hypertrophy) that happens in some patients with high blood pressure.
There are special considerations for using beta-blockers in women with asthma or lung disease.
Calcium channel blockers
Like beta-blockers, calcium channel blockers may be useful in women with diastolic heart failure because they lower blood pressure and slow the heart rate, giving the heart more time to fill with blood and helping relieve symptoms.
Diuretics cause your body to get rid of more fluid. Regardless of the type of heart failure, diuretics relieve the symptoms of heart failure caused by fluid buildup, such as shortness of breath and swelling in the legs.
Digitalis is a type of drug that increases the strength of the heart muscle’s contractions and slows the heart’s rhythm. A slower heart rate allows the heart more time to fill with blood in patients with blood filling problems. While studies on this drug’s effectiveness have been mixed, it may still be used to treat women with diastolic heart failure who have atrial fibrillation, and may be able to provide relief to patients with severe symptoms that have not been successfully treated with other medications.
Heart failure is a serious, life-long disease that will require significant changes to your lifestyle. With proper medication and rehabilitation, many women with heart failure are able to return to an active life. The more successful you are in making lifestyle changes, the better controlled your heart failure symptoms will be. You may also be able to take lower medication doses and avoid some troublesome side effects.
Lifestyle changes recommended for women with diastolic heart failure as the same as those for other types of heart failure, and include:
- Following a diet low in salt (like the DASH diet). Salt can cause extra fluid to build up in your body, making your heart failure worse.
- Limiting the amount of fluids that you drink to minimize heart failure symptoms caused by fluid buildup (shortness of breath, swelling)
- Weighing yourself often and telling your doctor if you experience sudden weight gain (a sign of excess fluid buildup in your body)
- Exercise training to help build up your fitness level, relieve symptoms, and improve your quality of life. Your doctor will tell you if you are stable enough for exercise and help you develop a safe exercise plan.
- Losing weight if you are overweight
- Quitting smoking if you smoke
- Not drinking alcohol excessively (your doctor may recommend that you stop drinking alcohol altogether)
See our article on Living with Heart Failure for much more information and tips on life after a diagnosis of heart failure.