What are the Symptoms of Diastolic Dysfunction?
Diastolic dysfunction itself often produces no symptoms at all, unless it progresses to the point of causing diastolic heart failure.
The heart failure that results from diastolic dysfunction is related to the stiffness of the left ventricle. ( Read about the causes of diastolic dysfunction here.) The stiffness of the left ventricle means that patients with this condition are prone to develop pulmonary congestion. This pulmonary congestion often occurs under conditions that may be well-tolerated by others. Such conditions commonly include atrial fibrillation, other kinds of rapid heart rhythms, periods of high blood pressure (especially systolic blood pressure elevations), and during episodes of cardiac ischemia. Indeed, since each of these conditions can occur suddenly and without warning, a common problem of diastolic heart failure is so-called "flash pulmonary edema" - sudden, severe, and potentially life-threatening pulmonary congestion, resulting in extremely severe breathlessness. Less severe episodes of pulmonary congestion are also commonly seen in patients with diastolic dysfunction.
How Common Is Diastolic Dysfunction?
Diastolic dysfunction is far more common than thought 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 presenting with diastolic heart failure are women.
When Does Diastolic Dysfunction Become Diastolic Heart Failure?
Diastolic heart failure is said to have occurred when a patient with diastolic dysfunction develops an episode of symptomatic pulmonary congestion.
How are Diastolic Dysfunction and Diastolic Heart Failure Diagnosed?
When an episode of symptomatic heart failure has occurred in a patient with a normal left ventricular ejection fraction, diastolic heart failure is diagnosed. It is now thought that up to 50% of patients presenting with acute pulmonary congestion may have diastolic heart failure.
In patients who have never had an episode of heart failure, diastolic dysfunction can be diagnosed by echocardiography, which can assess the characteristics of diastolic relaxation and of left ventricular "stiffness."
The echocardiogram can also reveal the cause of diastolic dysfunction: The ECG 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 have no other diagnostic findings. In these patients, attributing the diastolic dysfunction to a definite cause is often not possible.
More on Diastolic Dysfunction and Diastolic Heart Failure
An Overview of Diastolic Dysfunction and Diastolic Heart Failure.
The Treatment of Diastolic Dysfunction and Diastolic Heart failure.
Additional Links Related to 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.
