The diagnosis of diastolic dysfunction is now fairly common, especially among older women, most of whom are shocked to hear they have a heart problem at all. While some of these patients will go on to develop actual diastolic heart failure, many will not - especially if they get appropriate medical care, and also take care of themselves.
Still, it is now thought that almost half the patients who come to emergency rooms with episodes of acute heart failure actually have diastolic heart failure. The diagnosis of diastolic heart failure, unfortunately, is often missed by unwary physicians. Because once the patient presenting with diastolic heart failure has been stabilized, unless the doctor looks specifically for evidence of diastolic dysfunction on the echocardiogram, the heart can appear entirely "normal."
What is Diastolic Dysfunction and Diastolic Heart Failure?
( Click here for a primer on how the heart works. ) The cardiac cycle is divided into two parts - systole and diastole. During systole, the ventricles (the heart's major pumping chambers) contract, thus ejecting blood out of the heart and into the arteries. After the ventricles have finished contracting, they relax, and during this relaxation phase they re-fill with blood to prepare for the next contraction. This relaxation phase is called diastole.
Sometimes, however, due to various medical conditions, the ventricles become relatively "stiff." Stiff ventricles cannot fully relax during diastole, and as a result the ventricles may not fill completely, and blood can "dam up" in the body's organs (mainly the lungs). An abnormal "stiffening" of the ventricles, and the resulting abnormal ventricular filling during diastole, is referred to as diastolic dysfunction.
When diastolic dysfunction is sufficient to produce pulmonary congestion (that is, a damming up of blood into the lungs), diastolic heart failure is said to be present.
In general, when doctors use the terms diastolic dysfunction and diastolic heart failure, they are referring to isolated diastolic abnormalities - that is, diastolic problems occurring without evidence of systolic dysfunction, another type of heart failure.
What Are the Causes of Diastolic Dysfunction?
The major causes of diastolic dysfunction include:
- chronic high blood presssure
- hypertrophic cardiomyopathy
- aortic stenosis
- coronary artery disease
- restrictive cardiomyopathy (a rare condition in which the heart muscle is infiltrated, and made stiff, by abnormal cells, protein, or scar tissue. The most common cause of restrictive cardiomyopathy is amyloidosis, a disease in which protein-like substance is deposited within the body's tissues. Other causes include sarcoidosis and hemochromatosis.)
- aging (Whether age alone causes stiffening of the ventricles, or whether such stiffening is related to some other definable medical condition, is not yet worked out.)
More on Diastolic Dysfunction and Diastolic Heart Failure
The symptoms and the diagnosis 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.
