Heart failure is often misunderstood as a condition where the heart completely stops working. In reality, it refers to the heart’s inability to pump or fill with blood effectively. One specific and increasingly common form is chronic diastolic heart failure, also known as heart failure with preserved ejection fractions.
Understanding the diagnosis of chronic diastolic heart failure is essential because symptoms can be subtle, progress slowly, and are frequently mistaken for normal aging or other health conditions. This blog provides a clear and detailed overview of what chronic diastolic heart failure is, its causes, key symptoms, and how it is diagnosed.
What Is Chronic Diastolic Heart Failure
Chronic diastolic heart failure occurs when the heart’s lower chambers, known as the ventricles, become stiff and are unable to relax properly during the filling phase. While the heart may still pump out a normal percentage of blood, it does not fill with enough blood between beats. As a result, less oxygen rich blood reaches the body, leading to fatigue, shortness of breath, and fluid buildup.
Unlike systolic heart failure, where the heart’s pumping strength is reduced, diastolic heart failure is primarily a problem of relaxation and filling. The condition is considered chronic because it develops gradually and requires long term management.
How the Heart Is Affected in Diastolic Heart Failure
During a normal heartbeat, the heart goes through two main phases. In systole, the heart contracts and pumps blood out. In diastole, the heart relaxes and fills with blood. In diastolic heart failure, the relaxation phase is impaired.
The heart muscle may become thickened or stiff due to long standing pressure or structural changes. This stiffness prevents the ventricles from expanding fully, increasing pressure inside the heart and lungs. Over time, this leads to congestion and symptoms associated with heart failure.
Common Causes of Chronic Diastolic Heart Failure
Several conditions can contribute to the development of diastolic heart failure. Most are chronic health issues that place ongoing stress on the heart.
High Blood Pressure
Long term high blood pressure is one of the leading causes. When the heart has to pump against increased resistance, the muscle thickens to compensate. This thickened muscle eventually becomes stiff, impairing its ability to relax.
Aging
As people age, the heart naturally becomes less flexible. Older adults are more likely to develop diastolic dysfunction, especially when combined with other risk factors such as hypertension or diabetes.
Diabetes
Diabetes affects blood vessels and heart muscle function. High blood sugar levels contribute to inflammation and structural changes in the heart, increasing the risk of diastolic heart failure.
Obesity
Excess body weight increases the workload on the heart and contributes to conditions such as hypertension, diabetes, and sleep apnea. All of these factors raise the risk of diastolic dysfunction.
Coronary Artery Disease
Reduced blood flow to the heart muscle can lead to scarring and stiffness. Even without a prior heart attack, narrowed arteries may impair the heart’s ability to relax properly.
Atrial Fibrillation
Irregular heart rhythms disrupt normal filling patterns and can worsen diastolic dysfunction. Atrial fibrillation is commonly seen in patients with diastolic heart failure.
Key Symptoms of Chronic Diastolic Heart Failure
Symptoms of chronic diastolic heart failure often develop gradually and may worsen over time. Many patients initially dismiss symptoms as normal fatigue or aging, delaying diagnosis.
Shortness of Breath
One of the most common symptoms is shortness of breath, especially during physical activity. As the condition progresses, breathing difficulty may occur during rest or while lying flat.
Fatigue and Reduced Exercise Tolerance
Because the heart cannot deliver enough oxygen rich blood to meet the body’s demands, patients often feel tired and unable to perform activities they once managed easily.
Fluid Retention and Swelling
Fluid buildup may occur in the legs, ankles, feet, or abdomen. Some patients also experience rapid weight gain due to fluid retention.
Persistent Cough or Wheezing
Fluid congestion in the lungs can cause a chronic cough or wheezing, particularly at night or when lying down.
Rapid or Irregular Heartbeat
Palpitations may occur as the heart struggles to compensate for impaired filling. These sensations can feel like fluttering, racing, or pounding in the chest.
Difficulty Sleeping
Many patients find it uncomfortable to lie flat due to breathing difficulty. Needing extra pillows or waking up short of breath can be signs of worsening heart failure.
Why Diastolic Heart Failure Is Often Missed
Chronic diastolic heart failure can be challenging to diagnose because standard heart function tests may appear normal. Since the heart’s pumping ability is preserved, symptoms are sometimes attributed to lung disease, aging, or lack of fitness.
Additionally, symptoms may overlap with other common conditions, particularly in older adults who often have multiple health issues. This makes careful evaluation and targeted testing essential.
How Chronic Diastolic Heart Failure Is Diagnosed
Accurate diagnosis requires a combination of clinical evaluation, imaging studies, and laboratory tests. Physicians focus on identifying both symptoms and evidence of impaired heart relaxation.
Medical History and Physical Examination
The diagnostic process begins with a detailed review of symptoms, medical history, and risk factors such as hypertension, diabetes, or obesity. During the physical exam, providers may check for swelling, abnormal heart sounds, and signs of fluid congestion.
Echocardiogram
An echocardiogram is one of the most important diagnostic tools. This ultrasound of the heart allows physicians to assess heart structure, wall thickness, and how well the ventricles relax and fill. It also helps confirm that the ejection fraction is preserved.
Electrocardiogram
An electrocardiogram records the heart’s electrical activity. It can reveal abnormal rhythms, prior heart damage, or strain on the heart muscle.
Blood Tests
Certain blood tests help support the diagnosis. Elevated levels of natriuretic peptides may indicate increased pressure in the heart and fluid overload. Blood tests also help identify contributing conditions such as kidney disease or anemia.
Stress Testing
Stress tests evaluate how the heart responds to physical exertion. They can help identify exercise induced symptoms and assess blood flow to the heart muscle.
Cardiac Imaging
In some cases, advanced imaging such as cardiac MRI or CT scans may be used to assess heart structure, scarring, or underlying coronary artery disease.
Living With Chronic Diastolic Heart Failure
Although chronic diastolic heart failure is a serious condition, many patients can manage symptoms effectively with proper care. Lifestyle modifications play a critical role alongside medical treatment.
Patients are often advised to monitor weight daily, follow a heart healthy diet, reduce sodium intake, remain physically active within safe limits, and manage underlying conditions such as high blood pressure or diabetes.
Regular follow up with healthcare providers is essential to adjust treatment plans and monitor disease progression.
Potential Complications
If left untreated or poorly managed, chronic diastolic heart failure can lead to serious complications. These may include worsening fluid buildup, frequent hospitalizations, kidney dysfunction, and increased risk of arrhythmias or stroke.
Early diagnosis and consistent management significantly reduce the risk of complications and improve quality of life.
Conclusion
Chronic diastolic heart failure is a complex and often underrecognized condition that affects how the heart relaxes and fills with blood. Its symptoms can be subtle at first, but they progressively interfere with daily life if not addressed. Understanding risk factors, recognizing early warning signs, and obtaining an accurate diagnosis are critical steps toward effective management. As research continues to advance treatment strategies and diagnostic tools, individuals and caregivers may also choose to explore current ASCVD research studies, which are contributing valuable insights into cardiovascular disease prevention, heart failure management, and long-term patient outcomes.
