Treating Diastolic Dysfunction and Diastolic Heart Failure

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If you have been told you have diastolic dysfunction or diastolic heart failure, it is important for you and your doctor to work out a treatment plan - both to prevent and control your symptoms, and to reduce your chances of dying from this condition.

Treatment Strategy For Diastolic Heart Problems

The best strategy for treating diastolic dysfunction and diastolic heart failure is to attempt to identify any underlying causes, and then aggressively treat them.

In particular, the following possibilities must be addressed:

Hypertension.

You should be carefully evaluated for hypertension. Hypertension is often present in people who have diastolic dysfunction, and it can be tricky to diagnose. Worse, hypertension is very often inadequately treated. But if you have diastolic dysfunction, it is extremely important that your doctor take extra care to make sure your blood pressure is in the optimal range.

Coronary artery disease. (CAD)

People with diastolic dysfunction should also be evaluated for the presence of coronary artery disease (CAD); if CAD is diagnosed, it should be treated aggressively. Occult (that is, undiagnosed and asymptomatic) CAD is a common cause of diastolic dysfunction.

Atrial fibrillation.

If you have atrial fibrillation, this cardiac arrhythmia should be adequately treated.

The rapid heart rates commonly caused by atrial fibrillation can cause significant deterioration in cardiac function in people with diastolic dysfunction. So, rate control is critically important in anybody with atrial fibrillation and diastolic dysfunction.

Diabetes and obesity.

Diabetes and obesity are both associated with diastolic dysfunction. Losing weight and keeping diabetes under good control can help to stop the worsening of diastolic dysfunction.

Sedentary lifestyle

Many people with diastolic dysfunction lead habitually sedentary lives. A program of aerobic exercise training can improve the diastolic function of the heart and can be very helpful in diastolic dysfunction. In fact, an exercise program is the only treatment that has been demonstrated to improve the quality of life in patients with this condition. You should talk to your doctor about referring you to a cardiac rehabilitation program to get started.

Medications

In addition to identifying and treating any underlying causes, your doctor may also prescribe treatments aimed at reducing the symptoms of diastolic heart failure. Most commonly, diuretics such as furosemide (Lasix) are used to reduce excess sodium and water from the body, in order to reduce the symptoms of pulmonary congestion.

What is the Prognosis of Diastolic Dysfunction?

Patients who have had an episode of diastolic heart failure have a somewhat better prognosis than patients with traditional, systolic heart failure - but a far worse prognosis than patients without any heart failure.

This is why anyone who has had diastolic heart failure needs to be treated aggressively.

As for people who have been diagnosed with diastolic dysfunction but who have not had symptoms of heart failure, evidence is accumulating that these individuals also have a higher mortality than normal. This finding should not be surprising when you consider the underlying causes of diastolic dysfunction, and the propensity of doctors to "undertreat" the two most common of these (i.e., high blood pressure and undiagnosed coronary artery disease.)

Diastolic dysfunction is an important condition that, at the very least, should prompt a careful search for underlying causes and then aggressive treatment. The adequate treatment of diastolic dysfunction can greatly improve the likelihood of a good outcome.

Sources:

Gutierrez C, Blanchard DG. Diastolic Heart Failure: Challenges of Diagnosis and Treatment. American Family Physician. 69:11. 2004. Available at: http://www.aafp.org/afp/20040601/2609.html.

Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 2011; 32:670.

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