From the Guidelines
Diastolic dysfunction should be managed by controlling systolic and diastolic hypertension, using diuretics to control pulmonary congestion and peripheral edema, and considering the use of beta-adrenergic blocking agents, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, or calcium antagonists to minimize symptoms, as recommended by the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 1.
Key Recommendations
- Control of systolic and diastolic hypertension is crucial in managing diastolic dysfunction, with medications such as ACE inhibitors or ARBs being first-line treatments.
- Diuretics, such as furosemide, can help reduce fluid overload and alleviate symptoms.
- Beta-blockers, such as metoprolol, can improve diastolic filling by slowing heart rate.
- Lifestyle modifications, including sodium restriction, regular moderate exercise, weight loss if overweight, and smoking cessation, are essential in managing diastolic dysfunction.
Pathophysiology and Clinical Characteristics
Diastolic dysfunction is characterized by impaired ventricular relaxation, increased chamber stiffness, or both, resulting in elevated filling pressures despite normal ejection fraction. This condition often progresses with age and is commonly associated with hypertension, diabetes, obesity, and coronary artery disease.
Treatment Strategies
Treatment strategies for diastolic heart failure include treating hypertension and preventing or aiming for regression of hypertrophy, accomplished mainly by using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Strict volume control is necessary, obtained through diuretics and sodium restriction. Prevention of tachyarrhythmia and controlling the heart rate to optimize diastolic filling time are most often achieved using beta-blockers and calcium channel blockers.
Monitoring and Follow-up
Regular follow-up with echocardiography is important to monitor disease progression and treatment effectiveness. Patients should monitor for symptoms like shortness of breath, fatigue, and ankle swelling, which may indicate worsening condition.
From the Research
Definition and Prevalence of Diastolic Dysfunction
- Diastolic dysfunction is present in half of patients with hypertension and is associated with increased cardiovascular morbidity and mortality, as well as the development of heart failure 2.
- Diastolic heart failure is characterized by the symptoms and signs of heart failure, a preserved ejection fraction, and abnormal left ventricular diastolic function caused by a decreased left ventricular compliance and relaxation 3.
Risk Factors and Pathophysiology
- The predisposing factors for diastolic dysfunction include elderly age, female sex, obesity, coronary artery disease, hypertension, and diabetes mellitus 4.
- Hypertension induces a compensatory thickening of the ventricular wall, resulting in left ventricular concentric hypertrophy, which decreases left ventricular compliance and diastolic filling 3.
- There is an abnormal accumulation of fibrillar collagen accompanying the hypertension-induced left ventricular hypertrophy, which is also associated with decreased compliance and left ventricular diastolic dysfunction 3.
Treatment and Management
- Angiotensin converting enzyme inhibitors and angiotensin receptor blockers have been shown to be effective in improving measures of diastolic function and are recommended as first-line agents in the control of hypertension in patients with diastolic heart failure 2, 4.
- Beta-blockers, calcium channel blockers, and diuretics have also shown some efficacy in improving indices of diastolic filling 2, 4.
- Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, can also help prevent and treat hypertension, which is a major risk factor for diastolic dysfunction 5.
- Nonpharmacologic and pharmacologic management are effective and necessary to control the clinical signs and symptoms of diastolic heart failure and improve overall quality of life 6.