Medicines for diastolic heart failure
Diastolic heart failure occurs when the heart does not completely relax before it fills up with blood between heartbeats. This can result in blood that backs up into the lungs and the rest of the body. Experts know less about the treatment of diastolic heart failure than systolic heart failure for two reasons:
- It is hard to define diastolic heart failure precisely.
- Few clinical trials have found clearly effective strategies for treating diastolic heart failure.
The most common cause of diastolic heart failure is left ventricular hypertrophy caused by ongoing high blood pressure (hypertension). In this condition, the heart muscle thickens in response to higher-than-normal blood pressure in the arteries. This results in a smaller filling chamber in the heart and therefore a diminished ability of the heart to fill with blood. The heart also may not relax properly, which also affects how well the left ventricle fills.
The best therapy for diastolic heart failure caused by left ventricular hypertrophy is to treat the high blood pressure. Your doctor will usually prescribe drug treatment for diastolic heart failure itself only after treatment of its underlying cause is not effective in relieving symptoms.
Since no standard drug combinations exist for diastolic heart failure, your doctor will use your symptoms as a guide in choosing your drugs. Beta-blockers, calcium channel blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors all have some ability to decrease symptoms in some people.
Beta-blockers and calcium channel blockers. One of the main causes of diastolic dysfunction is that the heart does not have enough time to relax and fill before pumping blood out to the rest of your body. Beta-blockers and certain calcium channel blockers decrease your heart rate and allow more time for your heart to fill before pumping out blood with each beat. Another benefit of these medicines is that they also effectively reduce your blood pressure. This change can both slow and reverse the tendency of your heart muscle to thicken.
Diuretics. Just as in people with systolic heart failure, diuretics can improve symptoms in people with diastolic heart failure by removing excess fluid from the body. There is a delicate balance between too little removal of fluid and thus incomplete relief of symptoms and too much removal of fluid, which can lead to an increased heart rate and heart function that is worse.
ACE inhibitors. Some recent evidence suggests that this class of medicine can significantly improve symptoms in people with diastolic heart failure. This may be because these agents can lower the blood pressure and because of direct effects these medicines have on the heart muscle, both of which can lead to less thickening of the heart muscle and improved diastolic function.
| Author: | Douglas Dana Robin Parks, MS | Last Updated: October 23, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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