Diastolic dysfunction


Diastolic dysfunction

Description, Causes and Risk Factors:

A heartbeat is a two-part pumping action that takes about a second. The first part of the two-part pumping phase (the longer of the two) is called diastole. During diastole, blood collects in the ventricles. After the ventricles fill with blood during diastole, the heart muscle contracts. This second part of the pumping phase is called systole. Blood travels from the right ventricle into the lungs to pick up oxygen at the same time that oxygen-rich blood travels from the left ventricle to the heart muscle and the rest of the body.

Grades:

    Grade 1: The grade 1 diastolic dysfunction is a mild condition that can also be termed as the early stage of diastolic dysfunction. There are no clinical signs or symptoms in many patients.

  • Grade 2: The grade 2 diastolic dysfunction is also known as the pseudonormal filling dynamics. This is a moderate condition that shows elevated left atrial filling pressures. The symptoms include symptoms similar to heart failure. There may be left atrial enlargement due to elevated pressure in the left heart.

  • Grade 3 and 4: These are the most severe forms of the condition, where the patient may show advanced heart failure symptoms. The prognosis for grade 3 and 4 is generally very poor. The left atrial enlargement is observed and the systolic and diastolic dysfunction is indicated by the reduction in the left ventricular ejection fraction.

Diastolic dysfunction occurs when the ventricles cannot fill normally. In patients with certain types of cardiomyopathy and heart failure, the ventricles are unable to properly relax, and they become stiff. As a result, the ventricles may not fill completely, and blood can "dam up" in other parts of the body. The abnormal stiffening of the ventricles and the resulting abnormal ventricular filling during diastole is referred to as diastolic dysfunction. Internal ventricular pressure increases as blood from the next heartbeat tries to enter. The pressure "backs up" to produce fluid in the blood vessels of the lungs (pulmonary congestion) or the blood vessels leading back to the heart (systemic congestion). If left untreated, diastolic dysfunction can progress to diastolic heart failure.

Diastolic dysfunction is far more common than previously thought. Some echocardiographic studies found diastolic dysfunction in 15% of patients less than 50 years old, and in 50% of patients older than 70. Furthermore, up to 75% of patients with diastolic heart failure are women.

The incidence of diastolic dysfunction increases with age; therefore, 50 percent of older patients with heart failure may have isolated diastolic dysfunction. With early diagnosis and proper management the prognosis of diastolic dysfunction is more favorable than that of systolic dysfunction.

Symptoms:

Symptoms may include:

    Fatigue.

  • Breathing problems.

  • Shortness of breath.

  • Tachycardia.

  • Distention of jugular vein.

  • Edema.

  • Enlarged liver (hepatomegaly).

Diagnosis:

Currently, echocardiography is the key measure of diastolic function. Some data can be extracted from a nuclear stress test and cardiac MRI, but usually echocardiography is the way it is diagnosed.

Diastolic dysfunction

Treatment:

The mainstays of therapy, currently, are intensive blood pressure control and intensive heart rate control. This can often be achieved through regular physical activity, sometimes in combination with medicines. Usually, the use of an ACE-inhibitor or angiotensin receptor blocker to control blood pressure works best as it allows for heart remodeling, which may make the heart less stiff. Heart remodeling refers to the changes in size, shape, and function of the heart after injury to the ventricles.

Regular physical activity of up to 30 minutes a day (after checking with your doctor) is one of the best ways to reduce diastolic dysfunction - and in many patients exercise can serve as a cure for this condition.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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