Hello Jeffrey,
Welcome on this forum
Diastolic dysfunction itself often produces no symptoms at all, unless it progresses to the point of causing diastolic heart failure.
In recent years, a "new" type of heart problem has become widely recognized among cardiologists called diastolic dysfunction. When diastolic dysfunction becomes severe, diastolic heart failure can occur.
The diagnosis of diastolic dysfunction is now fairly common, especially among older women, most of whom are shocked to hear they have a heart problem at all. While some of these patients will go on to develop actual diastolic heart failure, many will not - especially if they get appropriate medical care, and also take care of themselves.
Still, it is now thought that almost half the patients who come to emergency rooms with episodes of acute heart failure actually have diastolic heart failure. The diagnosis of diastolic heart failure, unfortunately, is often missed by unwary physicians. Because once the patient presenting with diastolic heart failure has been stabilized, unless the doctor looks specifically for evidence of diastolic dysfunction on the echocardiogram, the heart can appear entirely "normal."
The cardiac cycle is divided into two parts - systole and diastole. During systole, the ventricles (the heart's major pumping chambers) contract, thus ejecting blood out of the heart and into the arteries. After the ventricles have finished contracting, they relax, and during this relaxation phase they re-fill with blood to prepare for the next contraction. This relaxation phase is called diastole.
Sometimes, however, due to various medical conditions, the ventricles become relatively "stiff." Stiff ventricles cannot fully relax during diastole, and as a result the ventricles may not fill completely, and blood can "dam up" in the body's organs (mainly the lungs). An abnormal "stiffening" of the ventricles, and the resulting abnormal ventricular filling during diastole, is referred to as diastolic dysfunction.
When diastolic dysfunction is sufficient to produce pulmonary congestion (that is, a damming up of blood into the lungs), diastolic heart failure is said to be present.
In general, when doctors use the terms diastolic dysfunction and diastolic heart failure, they are referring to isolated diastolic abnormalities - that is, diastolic problems occurring without evidence of systolic dysfunction, another type of heart failure.
People think of heart failure as a condition where the heart does not pump out enough blood. That is called systolic heart failure. However, many CHFers have a different kind of heart failure - caused when the heart does not fully relax, so it does not fill properly with blood.
In mild DHF, SOB and fatigue usually only happen during stress or activity. More severe DHF causes many of the same symptoms that systolic heart failure or SHF, causes.
A person with DHF has high pressures in the arteries of their lungs - pulmonary pressure. Their heart's pumping chambers may not be enlarged and their ejection fraction may be normal, but they still have the same nasty symptoms as a person with SHF.
Exercise in a healthy person makes the heart relax more quickly and lowers LV pressure faster. The heart muscle actually stretches and gets larger when full of blood just before pumping it out. This increases EF. In a healthy person, these actions help the body handle exercise.
In DHF, those actions are very limited. The heart's stiffness prevents it from stretching to increase its size when filled with blood. EF does not rise, and patients get short of breath and very tired. Often, there is quite a rise in blood pressure and heart rate during exercise. The rise in blood pressure makes the heart work harder, which screws up the entire pumping cycle.
These changes increase diastolic pressures. High diastolic pressures reduce lung function and make breathing harder. Low heart output during exercise causes fatigue in the legs and other muscles.
At this time its important for us to know what the diagnosis is, and what your cardiologist recommend.
greetings,
Corrij
