Diastolic Dysfunction

What is diastolic dysfunction?

Diastolic dysfunction is a problem with diastole, the first part of your heartbeat. During diastole, your lower heart chambers (ventricles) relax as they fill with blood.

Diastolic dysfunction may occur when your ventricles are stiff and don’t relax properly. When this happens, your ventricles don’t fill with blood as they should, and you may experience pressure buildup in your heart.

This can progress to diastolic heart failure, resulting in fluid buildup in your lungs, abdomen and legs.

What happens during diastole and systole?

When your heart beats, the top two chambers of your heart (atria) contract and push blood into the lower two chambers (ventricles). This process of blood filling the ventricles is diastole.

Then, your lower two chambers contract and send blood to your lungs and your aorta, your body’s largest artery. This contraction is systole.

What is the difference between diastolic dysfunction and diastolic heart failure?

Diastolic dysfunction that worsens may lead to diastolic heart failure, a type of left-sided heart failure. People with diastolic heart failure have a stiff left heart ventricle along with other heart failure symptoms, such as:

• Fatigue.
• Leg swelling.
• Nausea and loss of appetite.
• Shortness of breath (dyspnea).
• Weight gain.

Who might get diastolic dysfunction?

Anyone may develop diastolic dysfunction, but you are more likely to get it if you are:

• Older than 70.
• Physically inactive.
• Smoke or use tobacco products.

Or if you have:

• A body mass index (BMI) of 30 or above.
• Cardiomyopathy.
• Diabetes.
• High blood pressure.
• Coronary artery disease.
• Sleep apnea.

How does diastolic dysfunction affect my body?

As your top heart chambers continue to try to pump blood into your ventricles, you may experience pressure buildup. In turn, you may have fluid and pressure buildup in the blood vessels in your lungs (causing shortness of breath) or the blood vessels of your belly and legs (causing loss of appetite, and leg swelling).

Over time, diastolic dysfunction may lead to diastolic heart failure. It also is a leading cause of pulmonary hypertension or high blood pressure in the lungs. It may also be associated with atrial fibrillation.

Many people with diastolic heart failure have what is known HFpEF, or heart failure with preserved ejection fraction.

How common is diastolic dysfunction?

Diastolic dysfunction is common in older adults. Some experts estimate that about half of all adults over age 70 have some level of diastolic dysfunction. It’s less common in children and adults under 70.

What are the symptoms of diastolic dysfunction?

Many people have only mild diastolic dysfunction. You may feel out of breath when you exert yourself. As diastolic dysfunction worsens, shortness of breath may worsen, and you may develop symptoms of diastolic heart failure.

What causes diastolic dysfunction?

Several conditions and heart problems may lead to diastolic dysfunction, including:

• Coronary artery disease.
• Diabetes.
• High blood pressure (hypertension).
• History of heart attacks.
• Sleep apnea.

How is diastolic dysfunction diagnosed?

Your provider will likely use an echocardiogram to diagnose diastolic dysfunction. Echocardiograms are ultrasounds that measure how well your heart is pumping blood. It can also evaluate how well your heart valves are working.

What are the grades of diastolic dysfunction?

Healthcare providers use a grading system to determine how severe diastolic dysfunction is:

• Grade I is slightly impaired diastole. It is a common finding in people over age 60.
• Grade II is elevated pressure in the left side of your heart.
• Grade III is significantly elevated pressure in the left side of your heart.
• Grade IV is advanced heart failure with significantly elevated pressure on the left side of your heart.

How is diastolic dysfunction treated?

Treatment for diastolic dysfunction may include:

• Lifestyle changes: You may work with your provider to improve your habits. You may quit smoking, lower sodium intake or increase aerobic exercise. Your provider may also recommend a cardiac rehabilitation program to help you improve your overall heart health.
• Medications: Diuretics, or water pills, may help relieve some fluid buildup caused by diastolic dysfunction. If you have other health conditions, such as high blood pressure or diabetes, your provider may prescribe other medications to manage them.
• Left ventricular assist devices: These are implantable devices that help your heart pump blood. They assist your left ventricle with sending blood to your aorta. Left ventricular assist devices may be a treatment option if you’ve developed diastolic heart failure, although this is usually reserved in cases where people also have severe systolic heart failure.
• Heart transplant: Your provider may recommend a heart transplant in severe cases. Most people can manage diastolic dysfunction with less invasive treatment options.

How can I prevent diastolic dysfunction?

You can lower your risk of developing diastolic dysfunction by practicing heart-healthy habits. You may:

• Achieve and maintain a healthy weight for your body type, age and sex.
• Avoid tobacco and limit your intake of alcohol and caffeine.
• Eat a balanced diet full of fruits, vegetables, whole grains, healthy fats and lean protein.
• Exercise aerobically for at least 150 minutes per week.
• Follow your healthcare provider’s instructions to manage any health conditions and take all medications as directed.
• Limit your intake of saturated fats, sodium and processed sugar.
• Manage stress with healthy coping strategies, such as meditation or talk therapy.
• Sleep at least seven to eight hours nightly.

What can I expect if I have diastolic dysfunction?

Diastolic dysfunction can worsen and lead to heart failure without treatment. However, many people can manage the condition with lifestyle changes and medications.

It’s important to see your healthcare provider for regular screenings if you have diastolic dysfunction. Your provider will monitor the condition and offer additional treatments if your symptoms worsen.

What questions should I ask my doctor?

If you have diastolic dysfunction or think you could, you may want to ask your healthcare provider:

• What is the most likely cause of my symptoms?
• What are the early signs of diastolic dysfunction?
• What tests do I need to diagnose diastolic dysfunction?
• What are the treatment options for diastolic dysfunction?
• What lifestyle changes should I make to lower the chances of worsening diastolic dysfunction?

What is the number one cause of diastolic dysfunction?

Uncontrolled high blood pressure is the most common cause of diastolic dysfunction and diastolic heart failure.

How long can you live with diastolic dysfunction?

People with diastolic dysfunction who don’t have coronary artery disease tend to have a lifespan similar to an age-matched general population. The outlook is slightly less favorable if you have other heart problems and diastolic dysfunction, including coronary artery disease or systolic heart failures.

A note from Cleveland Clinic

Diastolic dysfunction occurs when the lower heart chambers don’t relax properly during diastole. As a result, you may experience pressure buildup in your heart chambers. Over time, diastolic dysfunction can lead to heart failure. However, many people successfully manage the condition with lifestyle changes, medications or other treatments.