Diastolic Heart Failure

• Introduction
• Diagnosis
• Treatment

Congestive heart hailure due to diastolic dysfunction of the left ventricle

Diagnosis

Correct diagnosis of heart failure is clearly a prerequisite. The diagnosis is based on symptoms, signs and the findings of appropriate investigations.

The chest XR may not reveal congestion in those with mild exertional dyspnoea or if the patient has been given diuretics. This group of patients may be the most difficult to diagnose since it is necessary to correctly attribute the patient's symptoms ensuring coexistent conditions such as obstructive airways disease are properly assessed. BNP levels may help in some instances, probably only if the test is done prior to treatment with diuretics. Normal BNP levels do not exclude the diagnosis of diastolic heart failure.

Left ventricular filling pressures can be estimated at echocardiography. Filling pressures estimation at echocardiograpy is altered by treatment with diuretics. For example, with "moderate diatolic dysfunction" the doppler pattern may be those of only "mild diastolic dysfunction". The findings of echocardiography need to be interpreted in the clinical context and at times some uncertainty remains. .

Hitesh Patel, Cardiologist
14 June, 2008

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