What is diastolic heart failure?

The heart squeezes and relaxes each time it beats. The squeezing part of a heartbeat pushes blood out of the heart and to the lungs and the rest of the body. This is called systole. After the heart has finished squeezing, it relaxes and refills with blood. This relaxation is called diastole.

The heart muscle can get stiff, making it hard for the heart to relax. This problem is called diastolic dysfunction. Pressure in the heart rises, and blood can back up into the lungs. When this happens it is called diastolic heart failure.

Diastolic dysfunction is very common. Many adults over age 70 have it. Usually the problem is not severe enough to cause diastolic heart failure.

What is the cause?

Diastolic dysfunction and diastolic heart failure may be caused by:

• High blood pressure
• A heart muscle that gets thick and stiff
• Heart valve problems
• Coronary artery disease, a problem with the blood vessels that bring blood and oxygen to the heart muscle

What are the symptoms?

Symptoms may include:

• Shortness of breath, trouble breathing, or coughing. At first these symptoms may happen just during exercise, then with any activity, and finally even when you are resting. You may wake up at night with trouble breathing or be unable to lie flat in bed because of shortness of breath.
• Swollen ankles, feet, and legs
• Weight gain caused by extra fluid in the body
• Feeling tired most of the time and not able to do your usual activities
• Lack of appetite and nausea
• Feeling like your heart is racing or fluttering
• Lightheadedness or fainting

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Chest X-ray
• An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat
• Echocardiogram, which uses sound waves (ultrasound) to see how well your heart muscle is pumping

How is it treated?

The first step is to find and treat the cause of the problem. This may mean treating high blood pressure with a change in lifestyle, with medicine, or by having surgery to replace a damaged heart valve.

Your healthcare provider may prescribe medicine to:

• Help you get rid of extra fluid in your body by urinating more
• Relax the heart muscle
• Relax blood vessels and lower blood pressure. This helps the heart to pump more blood out to the body.

How can I take care of myself?

If you have diastolic heart failure, there are things you can do to take care of yourself now and prevent problems in the future.

Follow your treatment plan and know how to take your medicines.

• Work as a partner with your provider. This means having regular provider visits and following your treatment plan.
• Follow the directions that come with your medicine, including information about food or alcohol. Make sure you know how and when to take your medicine. Do not take more or less than you are supposed to take.
• Many medicines have side effects. A side effect is a symptom or problem that is caused by the medicine. Ask your healthcare provider or pharmacist what side effects your medicine may cause and what you should do if you have side effects. Ask if you should avoid some nonprescription medicines.

Don’t smoke, eat a healthy diet, and watch your weight and blood pressure.

• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• Lose weight if you are overweight and eat a healthy diet.
  • Follow a low-salt (low-sodium) diet if it is recommended by your provider. Too much salt makes your body keep too much water and makes your heart have to work harder.
  • Follow your healthcare provider’s advice about how much liquid you should drink.
  • Ask your provider if you should avoid drinking alcohol. Alcohol can weaken your heart or may worsen heart failure. Also, some of your medicines may not work well if you drink alcohol.
• Weigh yourself every morning after you use the bathroom but before you eat or drink anything. Weighing yourself every day helps you know if extra fluid is building up in your body. A buildup of fluid is a sign that your heart failure may be getting worse. Weight gain can let you know about fluid buildup before you start having swelling.

  Keep track of your weight in a diary or on the calendar. Ask your healthcare provider when you should report weight gain. Letting your provider know about weight gain when it first happens can save you a trip to the emergency room or a stay in the hospital.

• Check your pulse and blood pressure every day. Learn how to take your own blood pressure or have a family member learn how to take it.

Be as physically active as you can.

• How active you can be depends on how bad the heart failure is. A program of gentle exercise helps most people. Your provider can tell you what level of exercise is right for you. Exercise helps your heart and body get stronger. It also improves your blood flow and energy level. Don’t exercise outdoors if it is very hot, cold, humid, or smoggy. Balance exercise with rest. Make sure that your activities don’t make you too tired or short of breath. Take rest breaks during the day.
• Avoid getting very hot or cold because it may make your heart work harder.

Try to lessen the stress in your life.

• Anxiety and anger can cause a fast heart rate and high blood pressure. If you need help with this, ask your healthcare provider.

Protect yourself against infections.

• Get a flu shot every year. When you have heart failure, you should not get the nasal spray vaccine (FluMist).
• Get the pneumococcal shot.

Ask your healthcare provider:

• How and when you will hear your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

How can I help prevent diastolic heart failure?

You can help prevent this disease with a heart-healthy lifestyle:

• Eat a healthy diet and keep a healthy weight.
• Stay fit with the right kind of exercise for you.
• Decrease stress.
• Don’t smoke.
• Limit your use of alcohol.

Talk to your healthcare provider about your personal and family medical history and your lifestyle habits. This will help you know what you can do to lower your risk.