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Diastolic Dysfunction

Diastolic dysfunction itself often does not cause any symptoms. However, if the problem progresses to the point that it starts to affect other organs and body parts, diastolic heart failure is diagnosed. In those situations common symptoms include:

  • Difficulty breathing and shortness of breath. Initially, this may only occur when exercising, but as the illness progresses, breathing can become problematic during any activity, including resting or lying down.

  • Unusual weight gain or swelling (edema) in the ankles, legs and abdomen.

  • Irregular or rapid heartbeat.

The main causes of diastolic dysfunction are:

  • Chronic hypertension

  • Coronary heart disease

  • Aortic stenosis

  • Hypertrophic cardiomyopathy

  • Restrictive cardiomyopathy


Diagnosis and treatment

When diastolic dysfunction is diagnosed it is by echocardiography, which enables assessment of diastolic relaxation and ventricular stiffness and thickening. It may also provide clues as to the cause of the problem.

Diastolic dysfunction is treated by aggressive management of the underlying cause. Approaches may include:

  • Strict control of hypertension

  • Aggressive treatment of coronary artery disease

  • Careful management or arrhythmia

  • The use of diuretics to control pulmonary congestion

If the underlying cause cannot be identified consider the possibility of undiagnosed hypertension, in which case careful monitoring is initiated. Undiagnosed coronary artery disease is also considered, in which case exercising testing can be used as a diagnostic tool.

Grading of diastolic dysfunction

- Diastolic relaxation abnormality (Grade 1)

          * Early stage

          * Normal resting end-diastolic pressures, but can become abnormal with activity

          * May contribute to exertional dyspnea

- Pseudo-normal filling (Grade 2)

          * Increased end-diastolic pressures at rest

          * Exertional dyspnea common

          * May contribute to peripheral edema

- Restrictive (Grade 3)

          * Advanced Stage

          * Markedly increase LV end-diastolic pressures at rest

          * Exertional Dyspnea/Peripheral edema

          * May contribute to dyspnea at rest

          * Poor prognosis

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