What is the recommended management for a 68-year-old female patient with fatigue and edema, and ECHO findings showing normal left ventricular systolic function, mildly increased left ventricular wall thickness, grade II diastolic dysfunction, and enlarged left atrial chamber dimension?

Management of Grade II Diastolic Dysfunction with Normal Ejection Fraction

For a 68-year-old female patient with fatigue and edema who has grade II diastolic dysfunction with normal left ventricular systolic function, diuretic therapy with furosemide is the recommended first-line treatment to alleviate symptoms and improve quality of life.

Understanding the Echo Findings

Your echocardiogram shows several important findings:

• Normal left ventricular systolic function (ejection fraction 57%)
• Grade II diastolic dysfunction (impaired relaxation of the heart)
• Mildly increased left ventricular wall thickness
• Enlarged left atrial chamber
• Normal right ventricular function
• No pulmonary hypertension (pulmonary pressure 31 mmHg)
• Normal inferior vena cava with normal right atrial pressure

What This Means

You have what's called "heart failure with preserved ejection fraction" (HFpEF). This means:

• Your heart can pump blood normally (normal ejection fraction)
• But it has trouble relaxing and filling with blood between beats (diastolic dysfunction)
• This causes symptoms like fatigue and fluid retention (edema)

Treatment Recommendations

1. Diuretic Therapy:

   • Furosemide (Lasix) is recommended to reduce fluid overload and relieve edema 1
   • Starting dose typically 20-40 mg daily, adjusted based on symptom response
   • This will help reduce the peripheral edema and improve your symptoms of fatigue

2. Blood Pressure Control:

   • If you have hypertension, controlling it is essential 2
   • ACE inhibitors like lisinopril may be beneficial 3
   • Target blood pressure should be <130/80 mmHg

3. Sodium Restriction:

   • Limit sodium intake to 2000-3000 mg per day
   • This helps reduce fluid retention and works with the diuretics

4. Regular Monitoring:

   • Echocardiography every 12 months to monitor heart function 4
   • Regular blood tests to check kidney function and electrolytes while on diuretics

What to Expect

• Diuretics should reduce your edema within days
• Fatigue may improve gradually over weeks
• You'll need to monitor your weight daily - sudden weight gain (2+ pounds overnight) may indicate fluid retention

Warning Signs to Report

• Worsening shortness of breath, especially when lying flat
• Increased swelling in your legs or abdomen
• Dizziness or lightheadedness (could indicate low blood pressure)
• Decreased urination despite taking diuretics
• New or worsening chest pain

Prognosis

With proper management, many patients with grade II diastolic dysfunction can experience significant symptom improvement. While there's no cure for diastolic dysfunction, controlling symptoms and preventing progression are achievable goals 5.

Potential Pitfalls to Avoid

• Overdiuresis: Too aggressive diuretic therapy can cause dehydration and kidney problems
• Ignoring progression: Regular follow-up is essential as diastolic dysfunction can worsen over time
• Overlooking other causes: Conditions like hypertension need to be well-controlled to prevent worsening of diastolic dysfunction 2

Remember that while your heart's pumping function is normal, the diastolic dysfunction requires ongoing management to control symptoms and maintain your quality of life.