Diastolic heart failure involves the left side of the heart. It causes a stiff left ventricle that prevents the heart from relaxing between beats. This means that the heart can’t pump an adequate amount of blood throughout the body or has to pump with increased pressure.

Both systolic and diastolic heart failure involve the left side of the heart. Both types of heart failure can eventually lead to right-ventricle heart failure over time.

However, there are important differences between the two. For example, with systolic heart failure, the left ventricle becomes weak and flaccid. With diastolic heart failure, the left ventricle bulks and hardens.

There are many symptoms, causes, and treatments for this high-mortality condition. Read on to learn more about diastolic heart failure.

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Diastolic heart failure happens when the heart does not relax properly between beats. This means it is unable to pump blood throughout the body the way it should and has to function at a higher pressure, which can cause symptoms.

If the heart pumps less blood, it means that less oxygen goes to vital organs and tissues.

Heart contractions and diastolic heart failure

When the heart muscles contract, known as the systole phase, the heart twists and closes slightly — like a wringing motion.

Then, in the diastole phase, the muscle fibers relax, unwind, and stretch.

Each of these motions is essential for allowing the heart to expand and draw blood into the ventricles.

With diastolic heart failure, the second phase of a heartbeat is challenged by its inability to relax. This means that the heart must work overtime to do its job.

Learn more about the systole and diastole phases here.

Vs. systolic heart failure

Systolic and diastolic heart failure both occur in the left ventricle of the heart, but can impact either the right or left ventricle.

Systolic heart failure happens when the pumps of the heart are not strong enough to move blood around the body effectively.

Diastolic heart failure means the heart does not relax correctly between beats.

A person can experience systolic and diastolic heart failure at the same time.

Learn about systolic vs. diastolic heart failure here.

Ejection fraction

Diastolic heart failure is also known as heart failure with preserved ejection fraction (HFpEF).

Ejection fraction is how doctors measure what percentage of the blood inside the heart is being pumped.

A healthy heart should pump blood at an ejection fraction of 55% or more.

If the ejection fraction is lower than this, it can mean there is damage or heart failure involving the left ventricle and systolic dysfunction is present.

The first symptoms a person with diastolic heart failure might notice are the same symptoms that come with any type of heart failure, including:

A person may notice that any kind of physical exertion, including day-to-day activities, become much more difficult due to fatigue and shortness of breath.

Learn about symptoms of congestive heart failure here.

According to the American Heart Association, there are two ways to stage heart failure.

The first is the New York Heart Association (NYHA) Functional Classification. This method examines a person’s physical ability, and has the following stages:

StageSymptoms
IPhysical activity does not cause problems for the person, like tiredness, palpitations, or shortness of breath.
IIThere are some limitations in the person’s physical activity.
The person feels comfortable when resting.
The person’s usual physical activity makes them tired, gives them palpitations, or causes shortness of breath.
IIIThere are substantial limitations in the person’s physical activity.
The person feels comfortable when resting.
Physical activities that are less difficult than daily tasks cause fatigue, palpitations, or shortness of breath.
IVThe person cannot do any kind of activity without experiencing discomfort.
The person notices symptoms of heart failure at rest.
If the person tries any kind of physical activity, they feel even more uncomfortable.

Another way of classifying stages of heart failure gives an objective assessment of cardiovascular disease:

StageObjective assessment
AA person is at risk of heart disease, but there are no signs of cardiovascular disease.
The person has no symptoms and can carry out their usual physical activities with no difficulty.
BA person is at risk of heart disease. The person has no symptoms. They feel some limitations during their usual activities.
The person feels comfortable when resting.
CThere are signs of structural heart disease.
The person feels or has felt limitations during their activity due to their symptoms. This includes activity that is usually less difficult than their daily tasks.
The person only feels comfortable when resting.
DThere are signs of severe cardiovascular disease.
The person feels severe limitations.
The person notices symptoms even when they are resting.

A doctor may use both of these methods together to classify a person’s stage of heart failure.

For example, if a person is experiencing no symptoms but their ejection fraction is 45%, they are NYHA Class I, Stage B.

Several factors may lead to a person being more likely to develop diastolic heart failure.

Who is most likely to have heart failure?

Heart failure is most common among older adults.

The American Heart Association writes that heart failure affects:

  • 7.8% of males and 4.5% of females aged 60–79
  • 8.6% of males and 11.5% of females aged 80 and older

Aging can lead to diastolic heart failure because the heart muscles naturally stiffen over time, since age decreases muscle elasticity.

Underlying conditions

Diastolic heart failure may arise from any number of pre-existing conditions, such as:

Is it hereditary?

Diastolic heart failure may also be hereditary.

People may be more prone to the condition if people in their family history had conditions that can cause it, like high blood pressure.

Additionally, there are certain types of genetic conditions linked to diastolic heart failure, such as hypertrophic cardiomyopathy, a heart muscle abnormality, that is an inherited condition. It causes the left ventricle walls to thicken and stiffen, which could lead to diastolic heart failure.

A doctor may order the following tests in order to diagnose diastolic heart failure:

  • Blood tests: A doctor may use blood tests to measure molecules that increase during heart failure, like brain natriuretic peptide. Blood tests may also show a doctor whether a person’s liver or kidney are working well.
  • Echocardiography: An echocardiogram can help a doctor measure a person’s ejection fraction.
  • Other imaging tests: A doctor may order more imaging tests to check a person’s heart function, such as:
  • Electrical tests: A person may require tests of their electrical functions, such as:
  • Stress tests: This type of test shows a doctor how well a person’s body can handle physical activity.

Learn what could cause an abnormal electrocardiogram here.

There is currently no cure for any kind of heart failure.

However, a person can improve their symptoms and outlook with the right treatment.

Behavioral changes

A person can take up heart-healthy habits to help treat and manage diastolic heart failure. These can include:

Learn about how to follow a cardiac diet here.

Medications

A person may require medicines that can help treat symptoms of diastolic heart failure, including:

TypeFunctionExample
Diuretics and aldosterone antagonistsReduce the amount of blood that the heart must pumpspironolactone
Blood vessel relaxersHelp the heart pump bloodangiotensin converting enzyme inhibitors like Entresto, or
angiotensin receptor blockers
Heart rate slowing medicinesHelp the heart pump bloodbeta-blockers or
ivabradine
Antiarrhythmic medicinesHelp the heart beat strongerdigoxin

A person with any kind of heart failure might need to follow a treatment plan forever.

After a person has experienced heart failure, they have the following survival rates:

TimeSurvival rate
1 year80–90%
5 years50–60%
10 years30%

However, the right treatment can help a person live a long and full life.

Diastolic heart failure directly affects the function of the heart, impairing its ability to pump blood to essential organs.

Though there is no known cure at this time, early diagnosis and treatment of heart failure symptoms are essential for managing the condition and extending life expectancy.