Systolic VS Diastolic Heart Failure

Introduction

Heart failure is considered to be a global public health condition. In the United States, one in 5 people aged 40 years will get heart failure during his or her life-span. Among the Elderly, Heart Failure remains the main cause of hospitalization.

Heart Failure is a condition in which heart will not be able to pump good amounts of blood to meet up with the demands of the body i.e. metabolic demands. This can occur from a cardiac disorder that is structurally or functionally affected, which affects the capacity of the ventricle to fill or give out the blood. Some of the medical conditions such as coronary artery disease (narrowing of the arteries), hypertension, slowly cause the heart to become weak or hard to fill and pump the blood effectively.

Ejection Fraction is one of the most important measures to know the functioning and pumping of the heart. Thus also helps to identify the classification of heart failure and treatments for the condition. The Ejection fraction of the heart should be 50 or higher, with every beat higher than half of the blood that fills the ventricle is pushed out with every beat. Sometimes, even though the ejection fraction is normal but the muscles of the heart gets stiff majorly from hypertension or other conditions. Heart Failure could affect the right side (ventricle), left side (ventricle) or both sides of the heart. The first thing the heart starts is with the left ventricle, which is the major pumping chamber of the heart.

The left-sided heart failure

The pumping action of the heart is that it moves oxygen and nutrient-rich blood to the left atrium and then to the left ventricle from the lungs, which then pushes the blood to different parts of the body. Left Ventricle is larger than the other chambers as it provides the major heart-pumping power. The left ventricle is important for the proper functioning of the heart. In conditions such as left ventricular heart failure, the heart’s left side has to pump harder to supply an equal amount of blood. In other word, no proper blood supply to different parts of the body.

Two types of Left-sided Ventricular Failure and the treatment for them is also different. Two-Types such as:

Systolic Failure (Heart Failure, in which the Ejection Fraction is reduced)

In this condition, the left ventricle is not able to contract appropriately. The force of the heart is not enough for the blood to be pushed into the circulation. In other words, the left ventricle does not contract appropriately, which results in problem-related to pumping. In this case the heart muscle becomes weak.

Diastolic Failure (Heart Failure, in which the Ejection Fraction is taken care of)

In this condition, the left ventricle is not able to relax properly due to the muscles becoming hard. The heart is not filled with proper blood, in between the heartbeats i.e. the resting period. In other words left ventricles have an issue with relaxation, resulting in a problem with the filling of the blood. In this case the heart muscle becomes hard.

Signs & Symptoms of Heart Failure

• Breathlessness
• Fatigue/weakness
• Swelling in your feet, legs, and ankle, and abdomen
• Too much of cough or making sound while you breathe
• Heartbeat is not regular or too rapid
• Faint kind of feeling
• Confused feeling
• Increases urgency to urinate at night
• Nausea
• Appetite has reduced to an extent

Causes for Diastolic Heart Failure

When an individual grows old, the elasticity of the blood vessels become less. This results in them becoming harder. The diastolic heart failure is too much seen among the older people. Apart from aging normally, the other causes which lead to diastolic blood pressure are:

High Blood Pressure

If an individual is suffering from hypertension, the heart has to work a bit more hard to pump the blood to different parts of the body. Because of the extra load of work on the heart, muscles of the heart become thick or large, resulting in becoming rigid/hard.

Diabetes

This is a condition in which the blood sugars remain high. The sugars are controlled by a hormone that is made by the pancreas which helps the transfer of glucose/sugar from food into the cells of the body to get energy. This disease results in the heart wall to become thick and finally getting rigid.

Coronary Artery Disease (CAD)

In this condition, the blood flow to the heart is clogged or gets lesser than compared to before.

Obesity or Overweight and Physical Inactivity/ Sedentary Lifestyle

Due to an increase in weight and too much pressure on the body, the heart has to work hard for the pumping of the blood.

Causes for Systolic Heart Failure

Heart Failure occurs mainly due to heart conditions or illness.

High Blood Pressure

When an individual has hypertension, it causes the heart to work hard, to pump excess blood to the body. Due to this excess work, the muscles of the heart gets thick and is not able to work appropriately.

Coronary Artery Disease (CAD)

The quantity of blood that flows to the heart is either clogged or the flow of blood is lesser compared to before.

Cardiomyopathy

In this case, the muscle of the heart is affected and harmed, due to which the pumping of the blood from the heart is not normal. In other words, it is known as heart muscles being harmed/injured. Problems in the valve of the heart: In many of the cases, the valve of the heart is not able to open or close properly or either becomes too leaky. In such cases, the pumping of the heart becomes hard to be transferred to different parts of the body.

Common Causes of Heart Failure

Myocarditis

This is defined as heart muscles being inflamed. This occurs due to virus and results in left-sided heart failure.

Congenital Heart Defects

When the heart chambers or valves have not yet formulated correctly or appropriately. This causes a healthy heart to pump blood in a more hard form, which fails the heart.

Arrhythmias

Heart Rhythm is not regular. This causes the beating of the heart too rapid, which causes an excess effort for the heart to work hard. A slow heartbeat also causes or results in heart failure.

Other Medical Conditions

Some of the long-term diseases such as HIV, Diabetes, Hyper and Hypothyroidism, a build-up of Iron (Hemochromatosis), or build-up of protein (amyloidosis), also results in heart failure.

Acute Failure is also caused by an attack by the virus that affects the muscle of the heart, severe infections, reactions which are caused by allergies, Lungs have blood clots, some medicines or any illness that causes the whole body.

Sleep Apnea

While sleeping in the night there is an issue with breathing, which results in decreased oxygen levels in the blood and the risk for irregular heart rhythm also increases. Both of these issues can make the heart weak.

Alcohol use

Excess intake of alcohol also causes the heart muscle to become weak and fails the heart. Alcohol intake could also come in-between the mechanism of the heart functioning and could cause the heart muscle to get the weak or irregular rhythm of the heart or dysrhythmias.

Tobacco Use: This also fails the heart.

Diagnosis for Heart Failure

Physicians will collect some details related to the patient. The first examination will be done, medical history will be collected, and few tests will be performed.

• To evaluate the Diastolic and systolic function, an echocardiogram will be done. This helps make an image of the heart using the sound waves for a video to be made of the same.
• Some of the blood tests to check the blood parameters: If there are any blood parameters which are abnormal or not in the normal range, it depicts the force it is adding on the organs due to a result of heart failure.
• Electrocardiogram (EKG): This helps to study the heart’s electrical activity.
• Chest X-Ray: Through a chest X-ray the doctor will come to know about the enlargement of the heart and also depicts the congestion.
• Stress Test or Exercise Test i.e. patient is asked to run on a treadmill: It depicts the response of the heart when it has to work hard.

• Heart Catheterization: In this case, there is an injection of the dye into the blood vessels, via the dye. It will depict the arteries being either blocked or weak.
• CT (Computerized Tomography) Scan: In this scan, the individual has to lie down on a table, inside a machine which is the size of a doughnut. The images of the heart and chest are collected, once the x-ray tube moves around the body.
• MRI (Magnetic Resonance Imaging) Scan: In this, the individual has to lie down on a long machine which is like a tube, which lines up the atomic particles inside a few of the cells. In front of the lined-up particles, radio-waves are transmitted, which produces signals which form images of the heart.
• Myocardial Biopsy: In this test, the physician puts a tiny, flexible cord used for biopsy inside the vein into your neck and groin and tiny bits of heart muscles are taken. This is used to evaluate the reason for heart failure which is majorly some type of heart muscle disease/illness.

Treatment

There is no cure for either systolic or diastolic heart failure. But there are things which could help relieve the symptoms and helps in better pumping of the heart. These could result in:

• Lifestyle changes: Important to follow a heart-friendly diet.
• Avoid a sedentary lifestyle. Important to exercise regularly.
• Important to maintain healthy body weight and Body Mass Index (BMI).
• Avoid smoking: This results in harm or injury to the blood vessels, causes hypertension, increases the heartbeat and decreases the quantity of oxygen in the blood. Avoid active as well as passive smoking.
• Avoid excess intake of alcohol.
• Avoid excess intake of fluids if recommended by the doctor.
• Avoid any sort of stress or depression.
• Check for swelling in legs, hands, feet, and abdomen
• Restrict Sodium in the diet: This helps avoid holding water and other fluids in the body, which might result in the heart working faster, hard, breathless and swelling of the legs, ankles, and feet.
• Proper sleep: If having any issues of breathlessness, then sleep properly with head raised, using a pillow.

Medications

As a part of treatment, important to take either one drug or a combination of drugs to see better results.

Medicines to be taken for diastolic heart failure includes:

• Diuretics i.e. that helps increase in the output of urine. There is an increase in the output of water from the bodies. This helps relieve swelling and any sort of edema.
• Mineralocorticoid Receptor Antagonist: This is a specific type of diuretic that helps relieve from excess salt and water from the body, but also helps maintain the potassium levels of the body.
• Medications to regulate blood pressure.

Medications for systolic heart failure include:

• Diuretics: This helps excretion of excess fluids from the body that helps avoid swelling. In other words, this is a water pill.

• ACE Inhibitors (Angiotensin-converting enzymes): This helps the heart to work in a better way by widening the blood vessels and decreases the blood pressure.

• Beta-blockers: This helps the heart rate to slow down and decrease blood pressure.

• Mineralocorticoid Receptor Antagonist: It is a type of diuretic, which helps relieve from excess salt and water, and helps keep to maintain potassium levels.
• Nitrate and Hydralazine: This helps the blood vessels to relax and open up.
• Digoxin: This helps to relieve heart failure symptoms.

Surgery and Devices

In some of the situations, you may need surgery to be done. Heart failure can be treated by various methods. If the condition is severe or serious, your doctor may insert a device or instrument named defibrillator or left ventricular assist device (LVAD) in your body. In some situations, even a heart transplant may be required, which will be best guided by the doctor.

Palliative Care

This is majorly a kind of treatment that is done to get relieved from the symptoms and improve their quality of life. There could be a point where it is a worsening condition, and medicines and even heart transplant may not work or is not a good idea for treatment. This time you need to take the help of the hospice. This means, that the patient is taken care of by the family, friends, nurses and other supports for their care and comfort. Hospice contributes to several supports such as psychological, social, emotional and spiritual.

Conclusion

It is never too late to start with lifestyle changes like avoid smoking, avoid alcohol, unhealthy diet, sedentary lifestyle. This will result in heart failure from not starting or worsening.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891535/
2. https://www.ncbi.nlm.nih.gov/pubmed/7713107
3. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.110.954388