When the heart is stiff and doesn’t relax properly between heartbeats
AN elderly woman can no longer walk as far as she could before.
She often feels tired and breathless no matter how much rest she has had.
Her legs are swollen.
This senior citizen in her 70s has problems lying down flat to sleep, because she ends up coughing.
Her weight has gone up above what is normal.
“If a person experiences such symptoms, he or she may be having diastolic heart failure.
“It’s best to see a doctor – to rule out kidney, liver and other problems,” explains consultant cardiologist Dr Lee Li Ching.
Diastolic heart failure (DHF) is a type of heart problem rather different from the popular image of heart attacks – that of a person clutching his chest as he feels pain, tightness or pressure there.
This is potentially a cause of systolic heart failure – when the heart is not strong enough to pump sufficient blood to the rest of the body (a heart attack causes pump failure, in other words, systolic heart failure).
You may have heard of the terms “systolic” and “diastolic” before when taking your blood pressure.
The systolic is the top number of the reading. It measures the force of blood against your artery walls while the main heart chambers (ventricles) squeeze to push blood out to the rest of the body.
Whereas the diastolic is the bottom number of your blood pressure reading. It measures the force of blood against the artery walls as the ventricles relax and are allowed to refill with blood.
DHF occurs when the heart is stiff and doesn’t relax properly between heartbeats. So it doesn’t fill up with as much blood as it should, and thus pumps out less blood to the rest of your body than a healthy heart would.
This decreased blood flow leads to the symptoms described above – fatigue and shortness of breath.
Moreover, when the heart is not able to pump efficiently, blood can back up into the veins from the lungs.
This eventually leads to fluid building up inside the lungs, a condition made worse when the person lies down flat.
Is DHF common?
“Diastolic heart failure is harder to diagnose, so it’s harder to collect data on it.
“Some of the symptoms could overlap with other problems such as kidney disease and blocked arteries,” explains Dr Lee, who is consultant cardiologist at the specialist heart hospital Cardiac Vascular Sentral Kuala Lumpur (CVSKL).
“In Malaysia, we don’t have specific data. But 6% to 10% of hospital admissions in the country are due to heart failure.”
How much is a person at risk of dying from this disease?
“Different studies show different mortality rates,” says Dr Lee.
“However, the five-year mortality from heart failure could be higher than some forms of cancer.”
Other conditions such as high blood pressure, diabetes, sleep apnoea, heart valve problems, blocked arteries and atrial fibrillation (irregular heartbeat) are commonly linked to DHF.
This can also indicate increased risk for the disease.
Still, it doesn’t mean that every elderly person who feels breathless has this condition. So how is DHF diagosed?
Even an electrocardiogram (ECG) may not pinpoint this disease.
The best way to find out is to do an echocardiogram, which is an ultrasound scan of the heart.
“This is the definitive test,” says Dr Lee.
“It will show any anatomical problems such as thickening of the heart walls. It will also show how stiff the heart walls are, whether they are relaxing properly (between beats).
“Echocardiograms are best done at a hospital. GP (general practitioner) clinics usually only do normal ultrasound for other organs.”
Treatment, lifestyle changes
Dr Lee says there is no “cure” as such for DHF, but heart function can be improved and the symptoms managed.
Various drugs are used to reduce the heart’s stiffness.
These include ACE (angiotensin-converting enzyme) inhibitors, and angiotensin receptor blockers (ARBs), which are also used to treat high blood pressure.
“The aim is to soften the heart, so that we increase the time in which blood can flow in to fill the heart chambers,” she says.
“We also use beta blockers to slow down the heart, so that the patient feels better.
“This is a mechanical approach to remodel the heart and deal with the disease.”
When a heart becomes more stiff and hard, there is a tendency to have more fibrous tissue.
“Anti-fibrotic medicines are used to prevent further build-up of such tissue.
Symptoms are also treated by doctors. “For example, we use diuretics to get rid of extra fluids in swollen legs,” she says.
The next step is to deal with other underlying problems, such as high blood pressure, diabetes and irregular heart rhythms (atrial fibrillation).
Those with sleep apnoea (a sleep disorder in which breathing repeatedly stops and starts, often characterised by loud snoring) are advised to use a CPAP (continuous positive airway pressure) machine. This maintains a mild pressure to ensure the airways are kept open.
“A CPAP machine also helps those with diastolic heart failure as it pushes out fluid from the lungs,” adds Dr Lee.
Doctors will also recommend a change in diet.
“A low-salt diet is better for diastolic heart failure. This is because salt encourages more absorption of water, and thus more fluid retention. This then raises blood pressure.
However, this can be a challenge as “Malaysian food tends to be salty, especially ‘outside’ food,” she adds.
Other recommended lifestyle changes include:
> Maintaining a healthy weight.
> Eating a heart-healthy diet.
> Regular, moderate exercise.
> Quitting smoking (or vaping).
> Limiting alcohol intake.
“Sometimes, patients have been having symptoms of diastolic heart failure for weeks or even months
“While it’s not (immediately) life threatening, the longer term prognosis could be worse than certain cancers. So it’s best to get it treated,” concludes Dr Lee.
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