The best strategy for treating diastolic dysfunction and diastolic heart failure is to attempt to identify the underlying cause and then aggressively treat it. 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 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 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. It is especially important to make sure the heart rate is sufficiently controlled 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.
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.
Recent evidence suggests that a program of aerobic exercise can improve the diastolic function of the heart and may be helpful in diastolic dysfunction. You should talk to your doctor about prescribing an exercise program for you.
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 is now a common diagnosis among patients admitted to the hospital for symptoms of 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 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.
