Diastolic Dysfunction
Diastolic Dysfunction: Grades, Symptoms & Treatment
Diastolic dysfunction overview
Diastolic dysfunction means that the main pumping chamber of the heart, the left ventricle, has become stiff or slow to relax, so it does not fill with blood as easily as it should between heartbeats. The heart usually still squeezes normally, which is why diastolic dysfunction is often discovered by chance on an echocardiogram, in people who have no symptoms at all.
Diastole is the resting phase of the heartbeat, when the ventricle relaxes and fills with blood. In a healthy heart the muscle relaxes quickly and fills almost without effort. When the muscle becomes thicker or stiffer, as happens with high blood pressure, ageing, diabetes and coronary artery disease, it relaxes more slowly and the pressure inside the ventricle rises. That higher pressure is transmitted back to the lungs, which can cause breathlessness, especially on exertion.
Diastolic dysfunction is an echocardiogram finding and a spectrum, not a single illness. It ranges from grade 1 (mild, very common and usually harmless on its own) to grade 3 (severe, with high filling pressures). When diastolic dysfunction causes symptoms such as breathlessness or fluid retention, the condition is called heart failure with preserved ejection fraction (HFpEF), which used to be called diastolic heart failure.
Diastolic dysfunction, HFpEF and heart failure: what is the difference?
Diastolic dysfunction – a finding on the echocardiogram: the left ventricle relaxes or fills abnormally. You may have no symptoms.
HFpEF – diastolic dysfunction (or related structural change in the heart) together with symptoms or signs of heart failure and a normal pumping strength (ejection fraction of 50% or more).
Heart failure – the wider syndrome, which includes HFpEF and the weak-pump form, heart failure with reduced ejection fraction (HFrEF). Our Heart Failure guide covers both.
How common is diastolic dysfunction?
Very common, and more so with age. In a large community study from Minnesota, about one in four adults aged 45 or over had some degree of diastolic dysfunction on echocardiography, and most of these were mild and caused no symptoms (Redfield et al., JAMA 2003). Mild grade 1 changes are seen in many healthy older adults and are often regarded as part of normal ageing.
Why the label matters less than the whole picture
What matters is not the words on the echo report but your symptoms, your blood pressure, your other echo findings and the underlying cause. A cardiologist reviewing your report can tell you whether it needs treatment, further tests or simply reassurance, and can explain what it means for you.
Diastolic dysfunction grades: grade 1, 2 and 3 explained
Echocardiography grades diastolic function from normal through grades 1, 2 and 3. The grade is worked out by combining several Doppler and tissue measurements, so no single number decides it. The same grade can mean different things in different people, which is why the report should be interpreted alongside your symptoms and history.
| Grade | Name | What is happening | Filling pressure | What it usually means |
|---|---|---|---|---|
| Grade 1 | Impaired relaxation | The muscle relaxes slowly, so the heart relies more on the atrium contracting to fill the ventricle | Normal or only slightly raised | Very common. Often a normal ageing change or an early sign of high blood pressure. Usually no symptoms |
| Grade 2 | Pseudonormal filling | The ventricle is stiffer. The filling pattern looks near normal only because pressure in the left atrium has risen | Raised | Moderate. More likely to cause breathlessness. The cause (blood pressure, coronary disease, atrial fibrillation) should be looked for |
| Grade 3 | Restrictive filling | The ventricle is very stiff. It fills rapidly and then stops abruptly | Markedly raised | Severe. Usually causes symptoms and needs prompt cardiology assessment to find the cause |
Grade 1 diastolic dysfunction
Grade 1 is the mildest and by far the most common grade. The ventricle is a little slow to relax, but pressures in the heart are normal. In most people over 60 it is simply a feature of ageing, in the same way that arteries stiffen and hair greys. It is also an early marker of long-standing high blood pressure, diabetes, obesity or lack of fitness, so it is a prompt to check these. In someone with no symptoms and a normal blood pressure, grade 1 usually needs no medicine and no further tests, only healthy-heart habits and sensible follow-up.
Grade 2 diastolic dysfunction
Grade 2 means pressure in the left atrium has risen to keep the ventricle filling. This is a more meaningful finding. It does not by itself mean heart failure, but if you also have breathlessness, ankle swelling or reduced exercise capacity, HFpEF is likely. It deserves a cardiologist’s review to look for the cause and to treat blood pressure, rhythm and any coronary disease.
Grade 3 diastolic dysfunction
Grade 3 is the most advanced grade, with a very stiff ventricle and high filling pressures. It is uncommon in the general population. When it is found, the cause should be actively sought, including conditions that stiffen the heart muscle such as amyloidosis, hypertrophic or restrictive cardiomyopathy, severe valve disease, constrictive pericarditis or advanced coronary or kidney disease. Treatment depends on the cause.
Can the grade change?
Yes. The grade can move in either direction depending on blood pressure, heart rate, rhythm (it is harder to grade accurately in atrial fibrillation), fluid status and the quality of the scan. Good blood pressure control, weight loss and exercise can improve diastolic function over time, and uncontrolled blood pressure or new atrial fibrillation can worsen it.
"Indeterminate" or "cannot be assessed"
Sometimes the report says diastolic function is indeterminate. This means the measurements disagreed with each other, which is common and does not mean something is wrong. Your cardiologist will interpret it with your symptoms and, if needed, other tests such as an NT-proBNP blood test or a diastolic stress echocardiogram.
Diastolic dysfunction symptoms and signs
Many people with diastolic dysfunction, especially grade 1, have no symptoms at all. When symptoms do occur they are the symptoms of HFpEF, and they are caused by raised pressure behind the stiff ventricle backing up into the lungs and body. They tend to come on gradually and are often put down to age, weight or lack of fitness.
Breathlessness
Breathlessness on exertion, such as climbing stairs, walking uphill or carrying shopping, which gradually reduces how far you can walk
Breathlessness when lying flat, needing extra pillows to sleep
Waking at night short of breath, needing to sit up or open a window
A dry persistent cough or wheeze, particularly at night or on exertion
Fluid retention
Swollen ankles, feet and legs that pit when pressed
Weight gain over days from retained fluid, or a tight waistband and bloated abdomen
Needing to pass urine more often at night
General symptoms
Tiredness and reduced stamina, with a sense that everyday tasks take more effort
Reduced tolerance of exercise, often the earliest and most subtle sign
Palpitations or a racing, irregular pulse, which may signal atrial fibrillation, a common companion and trigger
Breathlessness or tiredness that is much worse during or after a fast heart rhythm or a blood pressure surge
Symptoms are not specific
Breathlessness and ankle swelling have many causes, including lung disease, anaemia, obesity, deconditioning, kidney disease, thyroid disease and some medicines. A cardiologist will confirm whether the heart is responsible, because a diagnosis of diastolic dysfunction on an echo report does not prove that it is causing your symptoms. See our guides to shortness of breath and swollen ankles.
Causes and risk factors of diastolic dysfunction
Diastolic dysfunction develops when the heart muscle becomes stiffer or thicker, or when it is slow to relax. In most people more than one factor is involved. Finding and treating these factors is the main way to improve the condition.
Ageing
With age the heart muscle stiffens and relaxes less quickly, which is why mild diastolic dysfunction is so common in people over 60. This is a normal process but is accelerated by the conditions below.
High blood pressure
High blood pressure is the commonest cause. Years of pushing against raised pressure thickens the muscle of the left ventricle (left ventricular hypertrophy), which then becomes stiff. Good blood pressure control is the most powerful way to prevent diastolic dysfunction from progressing. See our hypertension guide.
Diabetes, obesity and metabolic syndrome
Type 2 diabetes, obesity and insulin resistance promote inflammation and stiffening of the heart muscle. Obesity in particular is strongly linked to HFpEF, and weight loss can improve symptoms.
Coronary artery disease and ischaemia
Reduced blood supply to the heart muscle stops it from relaxing normally, even when the pumping strength is preserved. Previous heart attack and narrowed coronary arteries are common causes. See coronary artery disease.
Atrial fibrillation
In atrial fibrillation the atria do not contract effectively, so the stiff ventricle loses the extra filling it depends on. Atrial fibrillation and diastolic dysfunction often occur together and each worsens the other. See atrial fibrillation.
Heart valve and muscle conditions
Aortic stenosis, which forces the ventricle to thicken
Hypertrophic cardiomyopathy, an inherited thickening of the heart muscle
Cardiac amyloidosis, in which abnormal protein stiffens the heart wall. It is increasingly recognised in older adults with HFpEF, and clues include carpal tunnel syndrome, nerve problems and unexplained thick heart walls
Restrictive cardiomyopathy and constrictive pericarditis, which are uncommon
Other contributors
Chronic kidney disease
Obstructive sleep apnoea
Lung disease and pulmonary hypertension
Excess alcohol, and some cancer treatments
Physical inactivity
Athletes
Most athletes have excellent diastolic function. Rarely, intense training causes changes that need to be distinguished from disease, which is one reason a specialist review of unusual echo findings is worthwhile.
Can diastolic dysfunction be prevented?
Often it can be delayed or prevented. Keeping blood pressure, weight, blood sugar and cholesterol under control, staying physically active, not smoking, limiting alcohol and treating atrial fibrillation and sleep apnoea all protect diastolic function.
When to see a doctor about diastolic dysfunction
Diastolic dysfunction found on a scan is not an emergency, but it should not be ignored if you have symptoms. Many people are reassured after a proper assessment, and some turn out to have a treatable underlying problem.
Arrange a prompt assessment if you have:
New or worsening breathlessness, or a reduced walking distance, that you cannot explain
Ankle swelling, or weight gain of more than 2 kg over 3 days
Needing more pillows, or waking breathless at night
A report that mentions grade 2 or grade 3 diastolic dysfunction, a dilated left atrium or raised filling pressures
Diastolic dysfunction together with high blood pressure, diabetes, atrial fibrillation or a family history of heart muscle disease
Palpitations, or an irregular pulse
If your report says grade 1 and you have no symptoms
This is very common and usually not urgent. Have your blood pressure checked, ask your GP or cardiologist whether any further tests are needed, and look after the risk factors listed under causes. If you want the report explained properly, a cardiac investigations review can help.
Call 999 immediately if you have:
Severe breathlessness at rest or unable to speak in full sentences
Chest pain or pressure, especially with sweating or breathlessness
Fainting or collapse
Coughing up pink or frothy phlegm
Sudden confusion, blue lips or severe weakness
How diastolic dysfunction is diagnosed
The aim of assessment is to find out whether the heart is the cause of your symptoms, to grade diastolic function accurately, and to find the reason for it. Diagnosing HFpEF is more difficult than diagnosing the weak-pump form of heart failure, because the pumping strength is normal and no single test is definitive.
1. History and examination
Your cardiologist will ask about symptoms, exercise tolerance, sleep, medicines, family history and conditions such as high blood pressure, diabetes, sleep apnoea and kidney disease. Examination includes pulse, blood pressure, weight, heart sounds, lung bases and signs of fluid retention such as swollen ankles and raised neck veins.
2. ECG
An electrocardiogram (ECG) looks for atrial fibrillation, thickened heart muscle, previous heart attack and conduction problems. Low-voltage QRS complexes with a thick heart wall on the echo can be a clue to amyloidosis.
3. Blood tests
An NT-proBNP (or BNP) test measures a hormone released when the heart is under strain. Under NICE guidance, a level above 2,000 ng/L suggests urgent specialist assessment, and 400 to 2,000 ng/L specialist assessment within 6 weeks. In HFpEF the level is often lower than in the weak-pump form, and it can be normal in people with obesity, so a normal result does not exclude HFpEF. Other blood tests check kidney function, electrolytes, blood count, iron status, thyroid function, HbA1c and cholesterol.
4. Echocardiogram: the key test
A full echocardiogram measures the ejection fraction, wall thickness, heart size, valves and pressures. Diastolic function is graded using several measurements combined, following the joint American and European guidance (Nagueh et al., 2016). The main ones are:
| Measurement | What it tells us | Abnormal if |
|---|---|---|
| E/e′ ratio (average) | Estimates the pressure inside the left ventricle during filling | Greater than 14 |
| e′ velocity (tissue Doppler) | How quickly the heart wall relaxes | Septal below 7 cm/s or lateral below 10 cm/s |
| Left atrial volume index | Size of the left atrium, a marker of long-standing raised pressure | Greater than 34 mL/m² |
| Tricuspid regurgitation velocity | Estimates pressure in the lung circulation | Greater than 2.8 m/s |
| E/A ratio and E velocity | The filling pattern, used to place the grade | Interpreted together with the above |
These thresholds are guides. Normal values change with age, and your cardiologist interprets them together with your blood pressure, heart rate and rhythm.
5. Tests to confirm HFpEF and find the cause
A stress echocardiogram or exercise diastolic test, which can unmask raised filling pressures that only appear on exertion
Cardiac MRI to assess scarring, thickening and conditions such as amyloidosis or hypertrophic cardiomyopathy
CT coronary angiogram or an invasive angiogram if coronary disease is suspected
Heart rhythm monitoring to look for atrial fibrillation, and a 24-hour blood pressure monitor to assess blood pressure accurately
A sleep study if sleep apnoea is suspected, and specialist tests for amyloidosis when the pattern suggests it
Scoring systems
When the diagnosis is uncertain, cardiologists use structured scores such as HFA-PEFF (European) or H2FPEF (which counts obesity, hypertension, atrial fibrillation, pulmonary hypertension, age over 60 and a raised E/e′ ratio) to estimate how likely HFpEF is.
Diastolic dysfunction treatment options
Treatment depends on whether you have symptoms. There is no medicine that simply “reverses” a stiff heart, so the approach is to treat the causes, relieve congestion if there is any, and protect the heart over the long term. Any medicine mentioned here should only be started or changed by your own doctor.
If you have no symptoms (diastolic dysfunction alone)
Control blood pressure, aiming for the target your doctor sets (NICE suggests under 140/90 mmHg in clinic, or under 135/85 mmHg at home, for most adults under 80)
Keep blood sugar, cholesterol and weight in a healthy range
Be active most days and avoid smoking and excess alcohol
Review periodically, with repeat echocardiography only if symptoms or the clinical picture change
If you have symptoms (HFpEF)
Diuretics (“water tablets”) relieve breathlessness and swelling by removing excess fluid. They improve symptoms but are used at the lowest effective dose
SGLT2 inhibitors (dapagliflozin or empagliflozin) reduce hospital admissions and worsening heart failure in HFpEF, and are now recommended by European guidelines and approved by NICE for this use (TA902, TA929)
Mineralocorticoid receptor antagonists (spironolactone, or finerenone in recent trial evidence) may be considered to reduce admissions, with kidney function and potassium monitored
Blood pressure medicines such as ACE inhibitors, angiotensin receptor blockers or others to reach target
Weight-loss medicines: in people with obesity and HFpEF, recent trials of semaglutide and tirzepatide improved symptoms, exercise capacity and weight. Whether they are suitable for you is an individual decision
Treating the cause
Atrial fibrillation: rate or rhythm control (including cardioversion or ablation) and anticoagulation when indicated
Coronary disease: antiplatelet and cholesterol treatment, and stents or bypass when appropriate
Aortic stenosis: valve replacement when indicated
Cardiac amyloidosis and hypertrophic cardiomyopathy: specific treatments now exist, which is why the cause is worth finding
Sleep apnoea: CPAP therapy
Medicines that may not help
Beta-blockers and heart-rate-lowering medicines do not improve outcomes in HFpEF unless there is another reason for them, such as angina, atrial fibrillation or a previous heart attack. A very slow heart rate can make filling worse, so these medicines should be reviewed in the light of your whole picture.
Exercise and cardiac rehabilitation
Supervised, structured exercise training is one of the most effective treatments for HFpEF. It improves exercise capacity and quality of life. Ask about cardiac rehabilitation or a graded walking programme.
Living with diastolic dysfunction
Most people with diastolic dysfunction lead full, active lives. The steps that help are simple and have a real effect on blood pressure, weight and symptoms.
Day-to-day self-care
Take medicines as prescribed and do not stop them without advice
Weigh yourself each morning after passing urine. Contact your doctor or nurse if your weight rises by more than 2 kg over 3 days
Check your blood pressure at home, ideally with a validated upper-arm monitor, and keep a record for appointments
Limit salt by avoiding added salt and processed foods. Fluid restriction is not usually needed unless advised
Keep alcohol within 14 units a week, spread over several days, and avoid binge drinking
Exercise
Aim for around 150 minutes of moderate activity a week, such as brisk walking, cycling or swimming, building up gradually. A little breathlessness is expected; stop and seek advice for chest pain, dizziness or severe breathlessness. Strength training twice a week is also helpful.
Weight, diet and sleep
Losing weight, if you are overweight, lowers filling pressures and improves symptoms. A Mediterranean-style diet is a sensible pattern. Treating sleep apnoea and sleeping with your head slightly raised can help night-time breathlessness.
Vaccinations and illness
Have the annual flu vaccine and ask about COVID-19 and pneumococcal vaccines. If you are on a water tablet, an SGLT2 inhibitor, an ACE inhibitor or similar and you become dehydrated through vomiting, diarrhoea or fever, ask your doctor or pharmacist about “sick day” advice, because some of these medicines may need pausing for a short time.
Driving and travel
Most people with diastolic dysfunction or well-controlled HFpEF can drive and fly. The DVLA says car drivers need not notify it of heart failure unless symptoms could distract them while driving. Check the DVLA guidance, and our DVLA cardiac assessment if you need a medical opinion.
Follow-up
Diastolic dysfunction prognosis and outlook
The outlook depends on the grade, whether you have symptoms and, above all, the cause.
Grade 1 without symptoms
The outlook is generally very good. Grade 1 is common in healthy older adults and on its own does not usually shorten life or limit activity. It does mark a slightly higher chance of developing high blood pressure complications or atrial fibrillation over the years, so it is a good reason to keep risk factors well controlled.
Grade 2 and grade 3
Raised filling pressures are linked with a higher risk of developing symptoms, atrial fibrillation and heart failure admissions. The risk depends strongly on the cause and on how well blood pressure, rhythm and other conditions are treated.
HFpEF
HFpEF is a long-term condition. Admissions to hospital with fluid overload are the main problem, and treatment with an SGLT2 inhibitor, diuretics where needed, and control of blood pressure, weight and atrial fibrillation lowers that risk. The long-term outlook varies widely between individuals and is not worse than the weak-pump form in all studies, which is why early recognition matters.
Can diastolic dysfunction improve?
Yes, in many people. Blood pressure control can reduce thickening of the heart muscle, weight loss and exercise improve filling pressures and fitness, and treating atrial fibrillation or coronary disease can improve function. Even when the stiffness remains, symptoms can improve markedly.
Diastolic dysfunction key facts
Diastolic dysfunction means the left ventricle is stiff or slow to relax and fills less easily; the pumping strength is usually normal
It is a spectrum: grade 1 (mild), grade 2 (moderate) and grade 3 (severe)
Grade 1 is very common, particularly over 60, and often needs no treatment beyond healthy habits and blood pressure control
With breathlessness, fluid retention or reduced exercise capacity, diastolic dysfunction is called HFpEF (heart failure with preserved ejection fraction)
High blood pressure is the commonest cause, followed by ageing, diabetes, obesity, coronary disease and atrial fibrillation
The echocardiogram is the key test; NT-proBNP, ECG and sometimes stress echo or cardiac MRI help confirm the diagnosis and find the cause
Treatment centres on treating the cause, SGLT2 inhibitors, diuretics for congestion, blood pressure and weight control, and exercise
Look for treatable causes such as atrial fibrillation, coronary disease, aortic stenosis and amyloidosis
Call 999 for severe breathlessness, chest pain or collapse
Guidelines and sources
This page follows current UK and European guidance and the research cited:
NICE NG106: Chronic heart failure in adults: diagnosis and management.
NICE NG136: Hypertension in adults: diagnosis and management.
NICE TA902: Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction and NICE TA929: Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction.
McDonagh TA et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal 2021;42:3599-3726, and the 2023 Focused Update. European Heart Journal 2023;44:3627-3639.
Nagueh SF et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Journal of the American Society of Echocardiography 2016;29:277-314.
Redfield MM et al. Burden of systolic and diastolic ventricular dysfunction in the community. JAMA 2003;289:194-202.
DVLA: Cardiovascular disorders: assessing fitness to drive (GOV.UK).
Diastolic dysfunction questions and answers
These are the questions patients most often ask about diastolic dysfunction and grade 1, 2 and 3 on an echocardiogram report.
What is diastolic dysfunction in simple terms?
It means the main pumping chamber of the heart, the left ventricle, is stiff or slow to relax, so it does not fill as easily between beats. The heart usually still pumps normally. It is a finding on an echocardiogram and ranges from mild (grade 1) to severe (grade 3).
Is grade 1 diastolic dysfunction serious?
Usually not. Grade 1 is the mildest grade, is very common with ageing, and often needs no treatment other than keeping blood pressure, weight and fitness healthy. It is worth checking for high blood pressure, diabetes and sleep apnoea, which can cause it.
Is diastolic dysfunction the same as heart failure?
No. Diastolic dysfunction is an echo finding that can exist without any symptoms. When it causes breathlessness, tiredness or fluid retention it is called heart failure with preserved ejection fraction (HFpEF), a type of heart failure.
What are the symptoms of diastolic dysfunction?
Many people have none. When symptoms occur they include breathlessness on exertion, needing extra pillows to sleep, tiredness, reduced exercise tolerance, swollen ankles, weight gain from fluid and palpitations. These symptoms are not specific and need assessment.
What causes diastolic dysfunction?
The commonest causes are ageing and high blood pressure. Diabetes, obesity, coronary artery disease, atrial fibrillation, aortic stenosis, chronic kidney disease, sleep apnoea and heart muscle conditions such as hypertrophic cardiomyopathy and amyloidosis also contribute.
How is diastolic dysfunction diagnosed?
It is diagnosed with an echocardiogram, which measures how the ventricle relaxes and fills using Doppler and tissue velocities. An ECG and NT-proBNP blood test, and sometimes a stress echocardiogram or cardiac MRI, help show whether it is causing symptoms and what the cause is.
Can diastolic dysfunction be reversed?
It can often be improved. Controlling blood pressure, losing weight, exercising, treating atrial fibrillation or coronary disease and treating sleep apnoea can improve diastolic function and symptoms, although in some people the stiffness persists and needs long-term management.
Do I need medicines if I have diastolic dysfunction but no symptoms?
Not necessarily. Treatment is directed at the cause, such as high blood pressure, diabetes or cholesterol. If you have symptoms of HFpEF, treatment may include a water tablet and an SGLT2 inhibitor. Your doctor should decide on medicines after reviewing your whole picture.
Can diastolic dysfunction cause chest pain?
Diastolic dysfunction itself does not usually cause chest pain, but it often coexists with high blood pressure and coronary artery disease, which can. New chest pain should always be assessed, and chest pain with breathlessness or sweating needs a 999 call.
Can I exercise with diastolic dysfunction?
Yes. Regular moderate exercise is one of the most effective treatments and improves exercise capacity and symptoms. Build up gradually and seek advice if you have chest pain, dizziness or severe breathlessness.
What is the life expectancy with diastolic dysfunction?
It depends on the grade, symptoms and cause. Mild grade 1 diastolic dysfunction without symptoms generally has an excellent outlook. HFpEF is a long-term condition, but treating the cause and using modern treatments reduces hospital admissions and improves quality of life.
Can I have my echo report explained privately?
Yes. A consultant cardiologist can review your echocardiogram report and images, explain the grade, check for a cause and advise on next steps through a telephone, video or face-to-face consultation, or a cardiac investigations review.
Questions to ask your cardiologist about diastolic dysfunction
Questions to ask your cardiologist
Bring this list to your appointment. It can help you get the most from your time with your cardiologist. Write down the answers so you can share them with your family.
What grade of diastolic dysfunction do I have, and which measurements on my echo led to it?
Is it causing my symptoms, or could something else (lungs, weight, anaemia, medicines) explain them?
Do I have heart failure with preserved ejection fraction, and how sure are we?
What is the underlying cause, and have blood pressure, diabetes, sleep apnoea, atrial fibrillation and coronary disease been looked for?
Do I need further tests, such as NT-proBNP, a stress echo, a cardiac MRI or heart rhythm monitoring?
Could amyloidosis or a heart muscle condition be present, and does my family need screening?
Would a water tablet or an SGLT2 inhibitor help me, and what side effects should I watch for?
What blood pressure and weight targets should I aim for?
How much exercise is safe, and can I be referred to cardiac rehabilitation?
How often should my echo and blood tests be repeated, and when should I seek urgent help?
Diastolic dysfunction diagrams and visual aids
What diastolic dysfunction means
Normal heart compared with diastolic dysfunction: the stiff, thickened ventricle fills poorly and pressure rises behind it.
Diagram: Dr Salam Salloum, uk-cardiologist.co.uk.
In diastolic dysfunction the muscle of the left ventricle is thicker and stiffer, so it relaxes slowly and holds less blood at a given pressure. The raised pressure is passed back to the lungs, which is why breathlessness is the main symptom when it causes problems.
From risk factors to symptoms
Risk factors stiffen the left ventricle; raised pressure behind it causes breathlessness and swelling.
Diagram: Dr Salam Salloum, uk-cardiologist.co.uk.
Diastolic dysfunction on its own, with no symptoms, is treated by managing the cause and risk factors. When it causes breathlessness, tiredness or fluid retention, the condition is called HFpEF and treatment is stepped up.
Treatment at a glance
The four pillars: treat the cause, relieve symptoms, protect the heart and healthy lifestyle.
Diagram: Dr Salam Salloum, uk-cardiologist.co.uk.
Treatment is built around finding and treating the cause, relieving fluid with a water tablet if needed, an SGLT2 inhibitor in HFpEF, and a healthy lifestyle with exercise and weight control. Any medicine should be prescribed by your own doctor.
If you have breathlessness, ankle swelling or an echo report showing diastolic dysfunction, you may benefit from a telephone consultation or video consultation to have your report explained and your treatment reviewed, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment.
Investigations such as echocardiography, exercise stress echo, ECG reporting and cardiac monitoring may be recommended to grade diastolic function and find the cause.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last reviewed: . This page is for general information and does not replace personal medical advice.