The important aspects of treating diastolic dysfunction and diastolic heart failure include aggressive management of the underlying cause. The major principles of treatment are as follows:
· Both systolic and diastolic high blood pressure is critical and should be aggressively managed.
· Coronary artery disease should be aggressively treated. Note that undiagnosed and asymptomatic coronary artery disease is a major cause of diastolic dysfunction.
Atrial fibrillation must be carefully managed. In patients with atrial fibrillation, rate control is good as arrhythmia control. But in patients with diastolic dysfunction, restoration of normal rhythm must be aggressively attempted for the better course. Aggressive heart rate management is mandatory, if atrial fibrillation persists.
· Pulmonary congestion must be controlled with diuretics pills that eliminate sodium and water via the kidneys.
Three things should be considered when there is no underlying cause for diastolic dysfunction is found. First, the common cause of diastolic dysfunction could be undiagnosed (or mild) high blood pressure. Careful management of high blood pressure would be useful. Second, undiagnosed coronary artery disease may be the cause of diastolic dysfunction although it is treatable. Undetected coronary artery disease may be identified with exercise testing in many patients with diastolic dysfunction. Third, an exercise program may be quite useful as aerobic exercise can improve the diastolic function of the heart.
What is the Prognosis of Diastolic Dysfunction?
Diastolic dysfunction is a “new” disorder” and it was unknown to cardiologists. However, it is rapidly being recognized and it is now one of the most common diagnoses by echocardiography labs.
Symptomatic diastolic dysfunction (diastolic heart failure): Somewhat better prognosis is observed in patients who have had an episode of diastolic heart failure than in patients with common systolic heart failure. But prognosis is far worse than patients without heart failure or diastolic dysfunction. Patients should be aggressively managed and treated even after their acute episodes of heart failure have been resolved considering its relatively poor prognosis.
Diastolic dysfunction without symptoms: A few studies have indicated that patients with asymptomatic diastolic dysfunction may have a higher mortality than normal. This observation may be true considering the underlying causes of diastolic dysfunction. Also, high blood pressure and undiagnosed coronary artery disease “under treated” by doctors. Diastolic dysfunction is an important condition and a careful search for underlying causes should be promptly searched. If nothing else, women who are prone to develop significant heart disease should be given careful attention considering the increasing recognition of diastolic dysfunction.