Diastolic Heart Failure

What is Diastolic Heart Failure?

Diastolic heart failure (DHF) also known as heart failure with preserved ejection fraction is the most common mimic of PAH.  Separating the two is critically important as they are treated differently.

Who gets DHF?

There are several important risk factors including diabetes, hypertension, sleep apnea, obesity, increasing age, female gender, coronary artery disease and left ventricular hypertrophy.  Any given patient does not have to have any or all of the above risk factors.  There are some less common causes of DHF such as radiation therapy that involved the heart and certain chemotherapies that are used for cancer treatment.

What are the symptoms of diastolic heart failure?

Unfortunately, the symptoms of diastolic heart failure are identical to pulmonary arterial hypertension.  Patients notice slowly progressive shortness of breath, decreasing exercise capacity, swelling of the ankles, fatigue and even chest pains.

How do you tell the difference between PAH and DHF?

Most of the time a careful history, physical exam, an echocardiogram and an EKG can point your doctor in the right direction.  There are characteristic findings on the echocardiogram that are very useful when present but their absence does not exclude the diagnosis of DHF.  In cases where it is not obvious whether a patient has DHF or PAH a right heart catheterization is required.  Often we perform a resting and exercise heart catheterization to separate pulmonary hypertension from diastolic heart failure.

What if I have diastolic heart failure but my doctor treats me for pulmonary arterial hypertension?

This can be a big problem.  None of the medicines for pulmonary arterial hypertension are approved by the FDA (Food and Drug Administration) for diastolic heart failure.  Furthermore, many of the PAH medicines can make DHF worse.