What are the symptoms of diastolic dysfunction?

Symptoms of Diastolic Dysfunction

The primary symptoms of diastolic dysfunction include breathlessness (dyspnea), fatigue, exercise intolerance, and ankle swelling, which result from elevated filling pressures despite preserved ejection fraction. 1

Clinical Presentation

Diastolic dysfunction presents with a characteristic symptom profile that reflects impaired ventricular filling and elevated cardiac pressures:

• Exertional dyspnea - Most common and earliest symptom, occurring when increased cardiac output demands during activity cannot be met due to impaired filling 2
• Orthopnea and paroxysmal nocturnal dyspnea - Breathlessness when lying flat or waking at night due to fluid redistribution
• Fatigue - Reduced exercise tolerance and early exhaustion during physical activity 2
• Peripheral edema - Ankle swelling due to elevated right-sided pressures 2
• Pulmonary congestion - Resulting from elevated left atrial and pulmonary venous pressures 1
• Chest pain - May occur with or without coronary artery disease due to subendocardial ischemia from increased wall tension and microvascular dysfunction 2

Pathophysiological Basis of Symptoms

The symptoms of diastolic dysfunction stem from specific hemodynamic abnormalities:

• Elevated filling pressures - Due to impaired relaxation and increased chamber stiffness, leading to increased left atrial pressure and pulmonary congestion 1
• Reduced stroke volume - Especially during exercise when diastolic filling time shortens 2
• Pulmonary venous hypertension - Results in dyspnea and orthopnea 1
• Exercise intolerance - Inability to increase cardiac output appropriately during exertion 3

Symptom Progression and Severity

Symptoms typically progress in the following pattern:

1. Early stage - Symptoms only with significant exertion (NYHA Class II)
2. Intermediate stage - Symptoms with minimal exertion (NYHA Class III)
3. Advanced stage - Symptoms at rest (NYHA Class IV) 2

Special Considerations

• Elderly patients - Symptoms may be attributed to aging or deconditioning, leading to delayed diagnosis 1
• Women - Higher prevalence of diastolic dysfunction, often with more pronounced symptoms 2
• Hypertrophic cardiomyopathy - Diastolic dysfunction is common and may cause symptoms even with minimal hypertrophy 2
• Atrial fibrillation - Poorly tolerated in patients with diastolic dysfunction due to loss of atrial contribution to ventricular filling 2

Diagnostic Challenges

• Symptoms are non-specific and overlap with other conditions
• Normal heart size on imaging despite significant symptoms 1
• Symptoms may fluctuate based on volume status, heart rate, and other factors 2
• Similar clinical presentation to systolic heart failure, requiring objective assessment of ejection fraction for differentiation 2

Clinical Implications

Understanding the symptoms of diastolic dysfunction is crucial for early diagnosis and management. Patients with unexplained dyspnea, especially elderly individuals with hypertension, should be evaluated for diastolic dysfunction even when ejection fraction is preserved. Proper identification of these symptoms can lead to appropriate treatment strategies that improve quality of life and potentially reduce morbidity and mortality.