Dyspnea and Diastolic Heart Failure

Diastolic heart failure is a condition in which the heart’s relaxation function is not normal. It is one of two main impairments that cause congestive heart failure, along with systolic heart failure (when the heart cannot contract and expel blood normally). Diastolic heart failure is the root problem in 50% of congestive heart failure patients and frequently the reason for heart patients’ shortness of breath, or dyspnea.

One of the characteristics of diastolic heart failure is increased pressures in the heart during the period of relaxation, or diastole. Such high pressures back up into the lungs and lead to shortness of breath and fluid accumulation in the lungs, which together characterize congestive heart failure. Diastolic heart failure patients do not exhibit symptoms like swollen legs, engorged neck veins, and shortness of breath when they are at rest. They may, however,  experience shortness of breath with exertion due to the increased pressure in their heart (dyspnea on exertion).

Risk factors for Diastolic Heart Failure:

A Different Kind of Heart Failure

Because diastolic heart failure is not as well recognized as other common medical problems, many patients who should be treated for diastolic heart failure are treated inappropriately for pneumonia, complications of chronic lung disease, uncontrolled hypertension or non-specific fluid overload. In order to combat this problem, Barnes-Jewish Hospital and Washington University Physicians have opened one of the first cardiologist-run dyspnea centers in the country.

The Cardiac Dyspnea Center (CDC) is a multidisciplinary outpatient clinic headed by Susan Joseph, MD, a cardiologist specializing in heart failure. Joseph says that primary care physicians often do not realize that their patients’ shortness of breath is due to heart failure because typical heart imaging reveals normal ejection fraction (squeezing function) of the heart. “One of the most important things we can do in our clinic is to raise the awareness of diastolic heart failure in the community. If you have a patient who has persistent shortness of breath without obvious abnormalities in their lung function or systolic heart function, that patient may have diastolic heart failure.”

Goals of the Dyspnea Center

Complete service for the diagnosis and management of patients with unexplained dyspnea or diastolic heart failure.

Joseph says, “Medically, we can’t at this point make this condition better with the drugs that work on systolic heart failure. However, we can improve symptoms and risk of hospitalization by instituting a structured exercise and dietary program, closely monitoring patients for signs of fluid overload, and aggressively modifying risk factors to reduce the conditions that aggravate the heart failure.”

 For patients who are diagnosed as having diastolic heart failure, the Center’s goal is to:

  • Prevent hospitalization through close follow-up and consistent protocols

  • Manage the condition on an outpatient basis through multidisciplinary evaluation and treatment for other conditions that may be exacerbating symptoms

  • Establish clinical criteria for making an accurate diagnosis, and to more effectively follow disease progression and response to therapy

  • Build the center in a way that will attract clinical trials and funding for new therapies

Dyspnea Center Team

Dyspnea on exertion Diagnosis Team

U.S. News & World Report Best Hospitals National Cardiology & Heart Surgery

#14 in the Nation
by U.S. News & World Report

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