From the Guidelines
No, congestive heart failure is not a diastolic murmur. Congestive heart failure is a clinical syndrome characterized by the heart's inability to pump blood effectively to meet the body's needs, resulting in symptoms like shortness of breath, fatigue, and fluid retention 1. A diastolic murmur, on the other hand, is a specific sound heard during cardiac auscultation that occurs during the diastolic phase of the cardiac cycle when the heart relaxes and fills with blood. While patients with congestive heart failure may have heart murmurs, including diastolic murmurs, as a result of underlying valvular abnormalities such as aortic regurgitation or mitral stenosis, the heart failure itself is not a murmur. Some key points to consider include:
- Approximately 20% to 40% of patients with heart failure have preserved left ventricular systolic function and are believed to have an impairment of ventricular relaxation as the primary mechanism leading to symptoms 1.
- The diagnosis of diastolic dysfunction is generally based on the finding of typical symptoms and signs of heart failure in a patient who is shown to have a normal left ventricular ejection fraction and no valvular abnormalities on echocardiography 1.
- The management of patients with diastolic dysfunction is frequently determined by a set of therapeutic principles, including control of blood pressure, control of tachycardia, reduction in central blood volume, and alleviation of myocardial ischemia 1.
From the Research
Definition of Congestive Heart Failure and Diastolic Murmur
- Congestive heart failure (CHF) is a condition in which the heart is unable to pump enough blood to meet the body's needs, leading to symptoms such as shortness of breath, fatigue, and swelling in the legs and feet 2.
- A diastolic murmur, on the other hand, is a type of heart murmur that occurs during the diastolic phase of the cardiac cycle, when the heart is filling with blood 2.
Relationship Between Congestive Heart Failure and Diastolic Dysfunction
- Diastolic dysfunction, which refers to the heart's inability to relax and fill properly during diastole, is a common cause of congestive heart failure, particularly in patients with preserved systolic function 3, 2, 4.
- Studies have shown that 30-40% of patients with CHF have normal systolic function, but diastolic dysfunction as the underlying disorder 2.
- Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), is a condition in which patients have symptoms and signs of heart failure, but normal left ventricular ejection fraction 3, 4.
Clinical Presentation and Treatment of Diastolic Heart Failure
- Patients with diastolic heart failure may present with symptoms such as shortness of breath, fatigue, and swelling in the legs and feet, similar to those with systolic heart failure 4.
- Treatment of diastolic heart failure typically involves symptom-targeted therapy, such as diuretics and nitrates, as well as disease-targeted therapy, such as treatment of hypertension and myocardial ischemia 4.
- Beta-blockers, which are commonly used to treat systolic heart failure, may also be beneficial in patients with diastolic heart failure, particularly in reducing symptoms and improving exercise tolerance 5.