Diastolic Heart Failure

Topic Overview

Diastolic heart failure occurs when the lower left chamber (left ventricle) is not able to fill properly with blood during the diastolic (filling) phase. The amount of blood pumped out to the body is less than normal.

What happens to the heart?

Diastole is the phase of your heartbeat when your heart relaxes and fills with blood. Diastolic dysfunction means that your left ventricle cannot relax properly during diastole. As a result, your ventricle doesn't fill with enough blood before it pumps. If diastolic dysfunction is severe enough, it can lead to heart failure.

Diastolic heart failure happens because the left ventricle's muscle becomes too stiff or thickened. To compensate for stiff heart muscle, your heart has to increase the pressure inside the ventricle to properly fill the ventricle. Over time, this increased filling causes blood to build up inside the left atrium and eventually into the lungs, which leads to fluid congestion and the symptoms of heart failure.

Diastolic heart failure may not lower the heart's ejection fraction. Ejection fraction is a measurement of how well the heart is pumping out blood. This ejection fraction is typically lower in people who have systolic heart failure. But in diastolic heart failure, your left ventricle may pump well during systole; it is just not filling with enough blood during diastole. Your ventricle may have a normal ejection fraction, but it has less blood inside it to pump out. As a result, your ventricle pumps out less blood with each beat. Doctors sometimes call it heart failure with preserved ejection fraction.

What causes it?

The most common cause of diastolic heart failure is the natural effect of aging on the heart. As you age, your heart muscle tends to stiffen, which can prevent your heart from filling with blood properly, leading to diastolic heart failure.

But there are many health problems that can impair your left ventricle's ability to fill properly with blood during diastole.

Causes of diastolic heart failure

Cause

What is it?

How it causes heart failure

Coronary artery disease (CAD) Blockage of the arteries that supply blood to the heart Low blood flow to the heart muscle (ischemia) can prevent the heart from relaxing and filling with blood.

High blood pressure

Elevated pressure in your arteries

Heart muscle can thicken the wall of the heart (hypertrophy) in an effort to pump against high blood pressure. Thickened heart muscle limits the heart's ability to relax and fill with blood.
Aortic stenosis Narrowed opening of the aortic valve The left ventricle thickens, limiting its ability to fill.
Hypertrophic cardiomyopathy Inherited abnormality of heart muscle resulting in very thick walls of the left ventricle Thick heart muscle prevents blood from filling the left ventricle.
Pericardial disease Abnormality of the sac that surrounds the heart (pericardium) Fluid in the pericardial space (pericardial tamponade) or a thickened pericardium (pericardial constriction) can limit the heart's ability to fill.

Related Information

References

Other Works Consulted

  • Yancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16): e147–e239.

Credits

By Healthwise Staff
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Last Revised November 8, 2013

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