How can diastolic heart failure be effectively managed?

Question

Hello doctor,

I am a 41-year-old male, 5 feet 11 inches tall, weighing 214 pounds. I have been diagnosed with multiple sclerosis and bipolar disorder as co-morbid conditions. Recently, I was admitted for a heart catheterization to investigate potential blockages after experiencing an abnormal ECG, chest and chin pain, months of breathlessness, and a strong family history of cardiovascular disease. Fortunately, no blockages were found. However, my cardiologist diagnosed me with diastolic heart failure. He specifically stated "heart failure," not just diastolic dysfunction.

My blood pressure has always been well-controlled. My medical report mentions moderate tortuosity of epicardial vessels consistent with hypertension, a hyperdynamic left ventricular ejection fraction of 75 to 80 percent, and moderate to severely elevated left ventricular end-diastolic pressure (24 mm Hg).

My cardiologist did not provide a prognosis. He advised me to follow a low-sodium diet and to get tested for sleep apnea, which I plan to do. However, he did not discuss what this diagnosis of diastolic heart failure means for my lifespan.

I have been managing health challenges for a long time, and understanding what this diagnosis means is essential for me. I am married with five children, and I would like to know what to expect.

Please provide advice.

Answer 1

Hello,

Welcome to icliniq.com.

I am sorry to hear that you did not receive a detailed explanation of your condition. Diastolic dysfunction refers to the inability of the heart to relax properly. It can be diagnosed through an echocardiogram or by identifying elevated pressures inside the heart chambers, as evidenced by the increased LVEDP (left ventricular end-diastolic pressure) noted in your cardiac catheterization report (24 mmHg, whereas normal is considered less than 15 to 18 mmHg).

The term diastolic heart failure is used when there is evidence of diastolic dysfunction, as described above, combined with symptoms of heart failure, such as the shortness of breath you mentioned. While some believe that diastolic heart failure is less severe than systolic heart failure, this is not entirely true. Prognoses for the two conditions are generally similar. However, patients with advanced systolic heart failure typically have a worse prognosis than those with diastolic heart failure. A complicating factor is that there are currently fewer proven therapies for diastolic heart failure. Treatment primarily focuses on a low-sodium diet, diuretics, regular exercise, proper nutrition, and overall lifestyle modifications.

To refine the diagnosis and assess the condition’s impact, it would be helpful to understand your exercise tolerance. However, this might be more challenging to evaluate given your multiple sclerosis.

I hope this information is helpful. My intention is not to discourage you but to encourage you to focus on what you can control through lifestyle changes. Eating well, managing stress (mindfulness or meditation may be helpful), and staying physically active within your limits are key to improving your quality of life.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Unfortunately, no test or series of tests can accurately determine your life expectancy. There are risk predictors for certain conditions, such as coronary artery disease, that use algorithms to estimate the likelihood of specific events, like having a heart attack within 10 years. Similarly, in the case of atrial fibrillation, these tools can assess the risk of having a stroke over a one-year period. However, for diastolic dysfunction or diastolic heart failure, it is not that straightforward.

Additionally, your exercise capacity would need to be taken into account. If you want a more objective assessment, you could consult a heart failure specialist to see if they recommend a cardiopulmonary stress test, which may provide a more detailed evaluation. Keep in mind, though, that this test might not be covered by your insurance.

I hope this helps you.

Thank you.