Diastolic Heart Failure

• Introduction
• Diagnosis
• Treatment

Congestive heart failure due to diastolic dysfunction of the left ventricle

Introduction

"Diastolic heart failure" and "heart failure with preserved left ventricular systolic function" are just two of the terms used to describe this condition. It is a condition where heart failure occurs when systolic function, even if reduced, is considered to be "satisfactory" and other significant conditions are absent, such as, for example, valvular heart disease.

In early diastolic dysfunction, there is delayed left ventricular relaxation and only a mild increase in left atrial pressure. Left ventricular compliance progressively decreases with worsening diastolic dysfunction. This progressive deterioration is associated with even higher left atrial and pulmonary venous pressures. As these pressures increase, the threshold for development of pulmonary oedema may be exceeded, initially with exercise and later also at rest.

Early diastolic heart failure may initially cause exertional dyspnoea without orthopnoea or paroxysmal nocturnal dyspnoea. Certain conditions may precipitate more severe heart failure. A large number of factors can cause deterioration, including labile hypertension and development of atrial fibrillation.

Hitesh Patel, Cardiologist
12th March, 2005

Selected references:

• Diastolic heart failure. N Eng J Med 2004;351:1097-105
• Heart failure with preserved left ventricular systolic function. J Am Coll Cardiol 2004;43:317–27