Diastolic heart failure (DHF) is a complex and often underdiagnosed condition affecting millions worldwide. It occurs when the heart muscles cannot relax properly during diastole, leading to impaired heart function and reduced blood flow to the body’s vital organs.
It affects the left ventricle and is also known as heart failure with preserved ejection fraction (HFpEF).¹
During rest, cardiac muscles stiffen, and the heart cannot properly fill with blood.
The subtype of heart failure is particularly prevalent among older adults and women, and its diagnosis and management remain challenging for clinicians.
However, advances in diagnostic techniques, including imaging and blood biomarkers, have improved the understanding of DHF pathophysiology and new treatment strategies that may improve patient outcomes.
This article elaborates on the causes and symptoms of diastolic heart failure and how to manage them.

Diastolic Heart Failure Stages

American Heart Association (AHA) proposes two ways to classify heart failure. Healthcare professionals may use either of these methods to stage a person’s heart failure.²

New York Heart Association (NYHA) Functional Classification

This staging method evaluates a person’s heart condition based on physical ability and symptoms:

Stage 1: Physical activity does not stress the heart. A person doesn’t experience any symptoms of heart failure with activity.
Stage 2: The person feels comfortable at rest and faces some limitations in physical activity. Routine activities can cause shortness of breath or palpitations.
Stage 3: A person experiences substantial limitations in activity. Even mild physical activity can cause fatigue or shortness of breath.
Stage 4: The patient experiences heart failure symptoms at rest and cannot do any activity without discomfort.

ACC/AHA Stages of Heart Failure

The American College of Cardiology/American Heart Association guidelines highlight an objective assessment of heart disease into the following stages:

A: At the risk. There is no cardiovascular disease, but the person possesses risk factors like family history or hypertension.
B: Pre-heart failure. Structural heart problems exist along with increased filling pressures, but the person has no disease symptoms.
C: Symptomatic heart failure. The patient has structural heart disease with one or more symptoms in the present or past.
D: Advanced heart failure. Notifiable symptoms interfere with individuals’ daily routines despite medical care.

ICD 10 Code for Diastolic Heart Failure

According to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), heart failure codes are included in category I50, except for rheumatic or congenital cases of congestive heart failure.

I50.3 Diastolic congestive heart failure
I50.30 Unspecified diastolic congestive heart failure
I50.31 Acute diastolic heart failure
I50.32 Chronic diastolic heart failure
I50.33 Acute on chronic diastolic heart failure³

Causes of Diastolic Heart Failure

Heart and blood vessels progressively lose their elasticity and are more likely to get stiff as we age. Some of the significant causes of diastolic heart failure are:

Advancing age⁴
Obesity
Hypertension
Diabetes
Coronary artery disease
Obstructive sleep apnea
Kidney disease

Symptoms of Diastolic Heart Failure

Most diastolic heart failure symptoms may not appear early. But you may experience the following conditions as the disease gets severe:

Shortness of breath at rest or during routine activities
Long-lasting cough or wheezing with white or blood-tinged mucous at the final stages of diastolic heart failure.
Swelling in the lower legs or abdomen
Unexpected weight gain
Nausea and loss of appetite
Faster heart rate or palpitations
Exercise intolerance⁵
Excessive fatigue and weakness

When to Seek Medical Care

At the initial stage, diastolic heart failure may remain unnoticed. However, you may experience some alarming signs as the condition progresses. The following symptoms require medical intervention and signals you need to see a doctor:

Shortness of breath
Irregular heartbeat or sudden increase in heart rate
Sudden swelling in the abdomen or lower legs
Weight gain
Long-lasting cough with bloody mucus
Chest pain
Feeling faint

Chest pain and other symptoms of worsening heart failure should be addressed immediately as a medical emergency.

Diagnosis of Diastolic Heart Failure

Your doctor may ask about your medical history to diagnose heart failure. Also, you might need specific tests to confirm the diagnosis. Here are some common diagnostic procedures for heart failure.

Electrocardiogram (ECG or EKG)

ECG is the most common way to diagnose heart problems. It can be useful for recording electrical activity in the heart. An ECG can indicate irregular heartbeats that may occur due to heart failure.

Blood Tests

Specific biomolecules, such as brain natriuretic peptide (BNP), increase in the blood due to electrolyte imbalance during heart failure. A blood test can help measure the levels of these biomarkers. Additionally, Troponin T or Troponin I are released in the blood when the heart muscle has been damaged, such as in a heart attack. The greater troponin T and I levels indicate greater damage to heart tissue.

Echocardiography

Echocardiography is an imaging test that uses ultrasound waves to produce images of the heart. In DHF, the heart cannot relax properly during the filling phase, leading to increased pressure within the heart chambers. Echocardiography can be useful in diagnosing it by showing the following:

Thickening of the heart muscle (known as hypertrophy)
Stiffness of the heart muscle
Abnormalities in the motion of the heart walls
Evidence of fluid accumulation in the lungs or other parts of the body due to congestion.
Echocardiography – The patient is taking a test to diagnose heart disease. Echocardiogram monitors and shows an image of the patient’s heart —medical ultrasound scan.

Other Imaging Tests

In addition to echocardiography, your doctor may recommend other imaging tests, such as CT or MRI. It can help check disturbances in a person’s heart structure or function.

Stress Test

A stress test is performed by administering medication or exercising stress to the heart. The performance of the heart under pressure is then monitored. It can help in the diagnosis of heart failure.

Cardiac Catheterization

Heart catheterization is a procedure that uses a catheter to monitor blood flow and heart pressure. A thin, flexible tube is passed through a blood vessel to the heart to identify or treat certain heart problems, like clogged arteries or irregular beats.

How is Diastolic Heart Failure Treated?

Currently, there is no complete cure for diastolic heart failure. The treatment generally aims to manage heart failure symptoms. Also, behavioral changes and lifestyle modifications can help improve the disease condition.

Lifestyle Modifications

Healthy habits can help treat the contributing factors, leading to successful disease management. The following are some common lifestyle changes that you need to make to improve your condition.

Staying Active
An active lifestyle is key to maintaining balanced health. Try to stay active with moderate aerobic exercise. It can help improve blood circulation and decrease the load on your heart muscles.
Taking a healthy diet
Use low-fat dairy products and eat many vegetables, fruits, and whole grains. Reduce the intake of sugar, salt, saturated fats, and cholesterol. Losing weight and maintaining a healthy weight puts less stress on the heart.
Avoiding Alcohol and Smoking
Stop drinking alcohol or limit its intake to very low. Also, you must avoid smoking as it damages blood vessels and raises blood pressure. Eventually, it can make the heart beat faster.

Medication Therapy

The right combination of medications depends on the nature of your heart failure and whether other conditions are present. Remember to take medications as your physician prescribes.

Blood Pressure Lowering Agents
Angiotensin-converting enzyme inhibitors (ACE inhibitors) like Captopril and Enalapril are commonly prescribed. Also, other antihypertensive agents can lower blood pressure, reducing the chances of it.
Diuretics
Loop diuretics like Furosemide reduce fluid accumulation in the body, as in edema. Lower fluid volume lowers blood pressure and reduces the risk of diastolic heart failure.
Aldosterone Antagonist
Spironolactone, an aldosterone antagonist, decreases the blood volume that the heart needs to pump. It helps remove excess fluid from the body by urination. Moreover, when used with other antihypertensive agents, Spironolactone helps manage resistant hypertension and diastolic heart failure.⁶
Antiarrhythmic Medications
Medications like Beta blockers and Digoxin can help treat irregular heart rates and palpitations. They can reduce the progression of heart disease by maintaining the heart rhythm.
Sodium-glucose cotransporter 2 Inhibitor
Empagliflozin is usually used with other medications. It can help reduce the risk of heart tissue necrosis and hospitalization in patients with diastolic heart failure.⁷

Surgery

Sometimes, the medication therapy is insufficient to manage diastolic heart failure. In this case, surgery is the recommended solution. Additionally, your doctor may go for an angioplasty to open a blocked artery. Also, heart valve repair or replacement can be another surgery option for diastolic heart failure.

Diastolic Heart Failure Prognosis

The prognosis varies depending on the cause, the severity of symptoms and impairment, the degree to which other organs are involved, and the patient’s response to medication therapy.
Moreover, the pathological origin also affects the disease prognosis. It depends on age, sex, methods used to diagnose diastolic heart failure, study design, the value of ejection fraction used as a threshold, and the underlying clinical conditions that caused diastolic heart failure.⁸

The Bottom-line

DHF is a condition directly linked to the heart that impairs its ability to pump blood effectively. Although it is not entirely curable, timely diagnosis and treatment may significantly improve a person’s quality of life and lifespan. Hence, it is imperative to get regular checkups and consult your physician in case of new symptoms or medication side effects. Early detection and management can be instrumental in improving outcomes and reducing the risk of complications.

Refrences

1
Bonow RO, Udelson JE. Left ventricular diastolic dysfunction as a cause of congestive heart failure. Mechanisms and management. Ann Intern Med. 1992;117(6):502–510. doi: 10.7326/0003-4819-117-6-502.
2
Classes of heart failure (2022) www.heart.org. American Heart Association. Retrieved February 24, 2023 from https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of-heart-failure
3
ICD-10-CM code for diastolic (congestive) heart failure i50.3- Codify by AAPC. Retrieved February 24, 2023 from https://www.aapc.com/codes/icd-10-codes/I50.3
4
Marantz PR, Tobin JN, Derby CA, Cohen MV. Age-associated changes in diastolic filling: Doppler E/A ratio is not associated with congestive heart failure in the elderly. South Med J. 1994;87(7):728–735
5
Packer M. Abnormalities of diastolic function as a potential cause of exercise intolerance in chronic heart failure. Circulation. 1990;81(2 Suppl):III78–86.
6
Tsujimoto, T. and Kajio, H. (2020) Spironolactone use and improved outcomes in patients with heart failure …, ahajournals.org. Journal of the American Heart Association. Retrieved February 24, 2023, from https://www.ahajournals.org/doi/10.1161/JAHA.120.018827
7
Anker, S.D. and Butler, J. (2021) Empagliflozin in heart failure with a preserved ejection fraction, nejm.org. The New England Journal of Medicine. Retrieved February 24, 2023, from https://www.nejm.org/doi/full/10.1056/NEJMoa2107038
8
Zile, M.R. and Brutsaert, D.L. (2002) New Concepts in diastolic dysfunction and diastolic heart failure: Part 1. Retrieved February 24, 2023 from https://www.ahajournals.org/doi/10.1161/hc1102.105289#d1e359

Diastolic Heart Failure: Causes, Symptoms, Treatments Explained

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