- Aggressive control of both systolic and diastolic high blood pressure, though often not accomplished by many doctors, is critical. ( Click here for a review of the management of high blood pressure.)
- Aggressive treatment of coronary artery disease is also critical. Notably, occult (meaning, undiagnosed and asymptomatic) coronary artery disease is a potentially important cause of diastolic dysfunction.
- Careful management of atrial fibrillation. Note that while rate control is as good as arrhythmia control in the average patient with atrial fibrillation, in patients with diastolic dysfunction, aggressive attempts to restore a normal rhythm may be the better course. If atrial fibrillation persists, then aggressive heart rate management is mandatory. (You can read about the different approaches to treating atrial fibrillation here.)
- Control of pulmonary congestion with diuretics (pills that eliminate sodium and water via the kidneys) is important.
If no underlying cause for diastolic dysfunction is obvious, three things should be considered. First, it is likely that undiagnosed (or mild) high blood pressure may be a common cause of diastolic dysfunction. Thus, careful monitoring for high blood pressure may be useful. Second, undiagnosed coronary artery disease is also a likely - and treatable - cause of diastolic dysfunction. Looking for previously undetected coronary artery disease with exercise testing is important in many patients with diastolic dysfunction. Third, aerobic exercise can improve the diastolic function of the heart - so an exercise program may be quite useful.
What is the Prognosis of Diastolic Dysfunction?
Diastolic dysfunction is a relatively "new" disorder; that is, until a few years ago it was poorly recognized even by cardiologists. However, it is rapidly becoming well-known, and indeed is now one of the most common diagnoses flowing out of echocardiography labs.
Symptomatic diastolic dysfunction (i.e., diastolic heart failure). 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 heart failure or diastolic dysfunction. Given this relatively poor prognosis, patients should be aggressively evaluated and treated even after their acute episodes of heart failure have been resolved.
Diastolic dysfunction without symptoms. At least two studies have suggested that patients with asymptomatic diastolic dysfunction 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. If nothing else, the increasing recognition of diastolic dysfunction should draw needed attention to the care of women who are prone to develop significant heart disease.
More on Diastolic Dysfunction and Diastolic Heart Failure
An overview of diastolic dysfunction and diastolic heart failure.
The symptoms and the diagnosis of diastolic dysfunction and diastolic heart failure.
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.
