Diagnosis of Diastolic Dysfunction and Heart Failure

Older woman coughing into her hand
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Diastolic dysfunction refers to the inability of the heart muscle to relax normally after each heart beat. Severe diastolic dysfunction can lead to diastolic heart failure.

Diastolic dysfunction itself most often produces no symptoms at all. However, severe symptoms are common with diastolic heart failure.

What Are The Symptoms?

The symptoms people experience with diastolic heart failure are similar to those seen with any form of heart failure.

With diastolic heart failure, the symptoms of lung congestion - breathlessness, coughing and rapid breathing - are especially prominent. People with diastolic heart failure often experience these breathing difficulties in the form of sudden episodes, which often occur without any warning. (This is different from the pattern typically seen in other forms of heart failure, in which shortness of breath usually “sneaks up” over a period of hours or days.)

The sudden, severe breathing difficulties common with diastolic heart failure are referred to as episodes of "flash pulmonary edema."

Medical conditions that can trigger flash pulmonary edema include atrial fibrillation and other kinds of rapid heart rhythms, periods of high blood pressure (especially systolic blood pressure elevations), and episodes of cardiac ischemia. Each of these medical conditions causes a further deterioration in the heart’s diastolic function.

While flash pulmonary edema is considered a hallmark of diastolic heart failure, patients with this condition may also experience less severe and more gradual episodes of breathing difficulties.

How Common Is Diastolic Dysfunction?

Diastolic dysfunction is far more common than thought even just a few years ago.

Some echocardiographic studies have detected diastolic dysfunction in 15% of patients less than 50 years old and in 50% of patients older than 70. Furthermore, it is largely a disorder of women - up to 75% of patients who have diastolic heart failure are women.

When Does Diastolic Dysfunction Become Diastolic Heart Failure?

Diastolic heart failure is said to be present when a patient with diastolic dysfunction develops an episode of pulmonary congestion severe enough to produce symptoms. If an episode of diastolic heart failure occurs once, it is extremely likely to happen again, especially if treatment is suboptimal.

How Are Diastolic Dysfunction and Diastolic Heart Failure Diagnosed?

Diastolic heart failure is diagnosed when a person has an episode of heart failure and subsequent evaluation shows that the systolic function of the heart is normal - that is, the left ventricular ejection fraction is normal. Up to 50% of patients who have episodes of acute pulmonary congestion turn out to have diastolic heart failure.

Diastolic dysfunction can be diagnosed by an echocardiogram, which can assess the characteristics of diastolic relaxation and the degree of left ventricular "stiffness."

The echocardiogram sometimes can also reveal the cause of diastolic dysfunction. The echo test can show the presence of the left ventricular muscle thickening associated with hypertension and hypertrophic cardiomyopathy. It can also show any aortic stenosis and of some types of restrictive cardiomyopathies. All of these conditions can produce diastolic dysfunction.

However, many patients who have diastolic dysfunction on echocardiography will have no other abnormalities to explain why the diastolic dysfunction is present. In these patients, it is not possible to attribute a specific cause to the diastolic dysfunction.

Sources:

Gutierrez C, Blanchard DG. Diastolic Heart Failure: Challenges of Diagnosis and Treatment. American Family Physician. 69:11. 2004.

Andersen MJ, Borlaug BA. Heart failure with preserved ejection fraction: current understandings and challenges. Curr Cardiol Rep 2014; 16:501.

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