Symptoms of Diastolic Dysfunction and Diastolic Heart FailureDiastolic dysfunction itself often produces no symptoms at all, unless it progresses to the point of causing diastolic heart failure.
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. And in distinction to the typical pattern of gradually worsening shortness of breath most often seen patients with other forms of heart failure, people who have diastolic heart failure often experience these symptoms in the form of sudden episodes, which often occur without any warning. These sudden episodes of severe breathing difficulties are referred to as "flash pulmonary edema."
Flash pulmonary edema may occur when certain underlying medical conditions worsen, leading to a further reduction in the diastolic function of the heart muscle. This sudden deterioration in diastolic function produces sudden lung congestion.
Medical conditions that can trigger these acute episodes include atrial fibrillation and other kinds of rapid heart rhythms, periods of high blood presssure (especially systolic blood pressure elevations), and episodes of cardiac ischemia.
While sudden episodes of severe lung congestion are considered typical with diastolic heart failure, patients with this condition may also experience less severe and more gradual episodes of shortness of breath.
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 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.
In patients who have never had an episode of 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 high blood presssure and hypertrophic cardiomyopathy, of aortic stenosis and of some types of restrictive cardiomyopathies.
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.
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.