From the Guidelines
Grade I diastolic dysfunction can cause leg swelling due to increased pressure in the heart's left ventricle during filling, which eventually leads to fluid buildup in the body, as patients may present with complaints of leg or abdominal swelling as their primary symptom, as noted in the 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults 1. In this condition, the heart muscle becomes stiff and cannot relax properly between beats, causing blood to back up into the lungs and venous system. As pressure increases in the venous system, fluid is pushed out of the blood vessels into surrounding tissues, particularly in the legs where gravity enhances this effect. This fluid accumulation, called peripheral edema, typically worsens throughout the day and improves with elevation of the legs. Some key points to consider in the management of Grade I diastolic dysfunction include:
- Controlling systolic and diastolic hypertension, in accordance with published guidelines, as recommended in the 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults 1
- Using diuretics to control pulmonary congestion and peripheral edema, as suggested in the 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults 1
- Addressing underlying causes like hypertension or diabetes, which is essential for improving outcomes in patients with Grade I diastolic dysfunction, as noted in the 2005 ACC/AHA guideline update for the diagnosis and management of chronic heart failure in the adult 1 Treatment often includes diuretics like furosemide (20-40mg daily) or hydrochlorothiazide (12.5-25mg daily) to remove excess fluid, along with lifestyle modifications such as sodium restriction (less than 2g daily), regular exercise, and elevation of the legs when sitting. In some cases, medications that improve heart function, such as ACE inhibitors or beta-blockers, may be prescribed to reduce the workload on the heart and improve its filling capacity, as recommended in the 2005 ACC/AHA guideline update for the diagnosis and management of chronic heart failure in the adult 1.
From the Research
Diastolic Dysfunction and Leg Swelling
- Diastolic dysfunction, including Grade I diastolic dysfunction, can lead to increased pressure in the left ventricle and left atrium, causing fluid to back up into the lungs and peripheral tissues, including the legs 2, 3.
- The increased pressure and fluid buildup can result in swelling in the legs, a common symptom of diastolic heart failure 2, 4.
- The pathophysiology of diastolic dysfunction includes delayed relaxation, impaired LV filling, and increased stiffness, which can lead to an upward displacement of the diastolic pressure-volume relationship and increased end-diastolic pressure 2.
Mechanisms of Leg Swelling
- The increased pressure in the left atrium and pulmonary veins can cause fluid to leak into the interstitial space, leading to edema in the legs 3, 4.
- The abnormal accumulation of fibrillar collagen accompanying hypertension-induced LV hypertrophy can also contribute to decreased compliance and LV diastolic dysfunction, leading to increased pressure and fluid buildup 4.
- The treatment of diastolic dysfunction, including Grade I diastolic dysfunction, should focus on controlling symptoms, such as leg swelling, and addressing the underlying cause of the dysfunction 2, 5, 3.
Diagnosis and Treatment
- Diagnosis of diastolic dysfunction can be performed using non-invasive techniques, such as Doppler-echocardiography, which can assess LV diastolic function and identify patients with diastolic dysfunction 2, 6.
- Treatment of diastolic dysfunction, including Grade I diastolic dysfunction, may involve medications such as calcium channel blockers, beta-blockers, ACE-inhibitors, and AT2-blockers, as well as lifestyle modifications, such as blood pressure control and exercise 5, 4.