HFpEF (Diastolic Heart Failure): Causes, Effects, and Treatment

HFpEF (Diastolic Heart Failure): Causes, Effects, and Treatment

It is hard when the heart cannot work well. Heart failure affects the cardiovascular system and daily life. One common type is HFpEF, or diastolic heart failure. Here, the heart’s left ventricular ejection fraction may be normal, but the ventricle is stiff and does not fill correctly. It alters the diastolic pressure-volume relationship and lowers cardiac output. People with HFpEF may have poor exercise tolerance and weak skeletal muscle. The condition can lead to chronic heart failure and cardiac injury. A heart failure specialist, such as those in SRM Global Hospitals, can diagnose heart failure using cardiac magnetic resonance (MRI) and other tests.

HFpEF- Diastolic Heart Failure

HFpEF, or Diastolic heart failure, is a problem with the heart’s filling phase. In this condition, the left ventricle pumps blood normally, but as the heart muscle stiffens, it cannot relax well to fill (regain) blood, and blood pressure rises very quickly as the heart fills. In India, the overall burden of heart disease is increasing, as about 19-25% of heart failure cases in India are of the HFpEF type. It means almost 2 out of 10 people with cardiac failure have this problem, making HFpEF a significant focus for cardiovascular care.

Preserved Ejection Fraction- HFpEF:

In Heart failure, Ejection fraction shows how much blood the left ventricle pumps out.

If the number stays,

  1. Above 50%- the blood pumping strength will usually be fine as preserved ejection fraction
  2. Between 41% to 49%- the blood-pumping strength of the heart slows down due to mild ejection failure.
  3. Below 40%- the blood-pumping strength of the heart leads to severe, reduced ejection failure

HFpEF usually falls in the category of preserved ejection fraction, where the blood-pumping strength is above 50%, but it still carries risk. Studies show a yearly heart-related death rate in HFpEF is above  20%, on average, in the southern parts of India.

Heart Failure with Preserved Ejection Failure- Causes and Effects

Affected patients with HFpEF often show several key symptoms, as exercise intolerance and feeling tired easily when moving around. For many HFpEF patients, the quality of life is severely reduced. The median distance walked in six minutes (a measure of exercise tolerance) for these patients is often less than 300 meters=, which is much lower than that of healthy individuals. Apart from this, they could also be affected by other severe heart conditions due to high blood pressure, and, in severe cases, this can lead to fluid buildup in the lungs and the rest of the body.

More than 75% of people with HFpEF have a history of high blood pressure, with other conditions like coronary artery disease or diabetes mellitus, which often worsen the problem. It is a significant risk factor, as over time, uncontrolled high blood pressure forces the left ventricle to work harder. It leads to a thickened heart muscle and a stiffened ventricle, further worsening diastolic dysfunction.

In severe cases of heart failure associated with HFpEF, chronic obstructive pulmonary disease, valvular heart disease, and ischemic heart disease, the clinical status can change and raise the chance of cardiovascular death. Atrial dysfunction also adds stress on the left side of the heart, and these long-term issues increase the risk of severe heart failure and cardiovascular mortality.

Pulmonary Hypertension and Congestive Heart Failure:

The increased blood pressure in HFpEF can also spread backwards into the lungs, leading to pulmonary hypertension (increased pressure in the lungs). About 68% of HFpEF patients show signs of pulmonary hypertension.

Pulmonary hypertension with HFpEF can also cause right ventricular dysfunction and congestive heart failure (fluid buildup in the body). People feel breathless when they lie down or walk a short distance, and also have swelling in their legs due to high blood volume overload. Swelling in the legs, feet, or belly is common in this condition. This swelling indicates that the heart cannot meet the body’s needs due to diastolic dysfunction in HFpEF.

Many patients with HFpEF also live with chronic kidney disease, high systolic blood pressure, or atrial fibrillation. These issues raise stress on the heart and increase the chance of congestive heart failure. Some people face high-output heart failure due to long-term illness. Some patients develop diastolic failure due to increased ventricular stiffness and incomplete myocardial relaxation.

Patients with HFpEF- Treatment and Care

A good ejection fraction of HFpEF does not make the illness mild. Doctors, including those at SRM Global Hospitals, use advanced cardiac MRI to assess the heart’s shape and muscle health for a precise diagnosis. Heart failure society groups and heart failure association bodies share clear clinical practice guidelines for care. A heart specialist checks the left atrium, left ventricular mass, cardiac structure, and cardiac function to spot early signs of severe heart failure, which may be elevated in HFpEF.

The treatment plans and medications for HFpEF are simple yet highly proven. These steps from several clinical trials showed effective clinical outcomes, helping patients experience less breathlessness and relax from heart muscle stiffness.

Beta blockers

Beta blockers help slow down the heart rate. In HFpEF, this is useful when atrial fibrillation causes the heart rate to be too fast. Slower heartbeats give the stiff heart more time to fill with blood. They can also reduce symptoms like shortness of breath and fatigue.

Angiotensin-converting enzyme

ACE inhibitors lower blood pressure and reduce stress on the heart. In HFpEF, high blood pressure can make the left ventricle stiffer. These medicines help the heart relax better and prevent further damage. They also protect the kidneys, which can be affected in chronic heart failure.

Diuretic therapy

Diuretics help the body eliminate excess fluid. In HFpEF, fluid can accumulate in the lungs and legs, leading to breathlessness and swelling. Diuretics reduce this fluid, making it easier to breathe and move around. They help improve daily comfort but do not alter the heart’s stiffness.

Reasonable care is not complex! Clear checks, simple medicines, and steady follow-up help reduce risk. Early action helps protect the heart- gives a safer path and helps stay active for more years.

HFpEF is a diastolic heart failure condition where the left ventricle becomes stiff, lowering cardiac output and causing exercise intolerance, breathlessness, and swelling. Early diagnosis, cardiac MRI tests, clear checks, simple medicines, and steady follow-up help reduce risk, protect heart health, and support daily life. Take Care of Your Heart at SRM Global Hospitals! SRM Global Hospitals offers advanced cardiac care with expert specialists, advanced tests, and personalised treatment plans.

Schedule a consultation today to protect your heart and improve your quality of life.

FAQs on HFpEF/ Diastolic Dysfunction

What does a normal ejection fraction mean in HFpEF patients?

A normal ejection fraction means your heart pumps out blood well. But in HFpEF, the heart is stiff and does not fill correctly. You may still feel tired or short of breath even with a normal ejection fraction.

Why does HFpEF raise the risk of systolic heart failure later?

In HFpEF, the stiff heart works harder over time. It can weaken the heart’s pumping function, leading to systolic heart failure later.

When do doctors use invasive hemodynamic evaluation for HFpEF?

Doctors use it when regular tests do not explain your symptoms. It measures the pressure inside the heart to detect problems.

Why is cardiac output important for people with HFpEF?

Cardiac output is the amount of blood the heart pumps into the body. Low output can make you feel weak, tired, and short of breath.