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What's The Difference Between Systolic And Diastolic Heart Failure?

In systolic heart failure, the heart cannot effectively contract with each heartbeat. In diastolic heart failure, your heart cannot relax between heartbeats. Both types can lead to right-sided heart failure.

Heart failure occurs when your heart is unable to pump the amount of blood your body needs to keep you healthy. It can occur on the left or right side of the heart or on both sides.

The left side is in charge of pumping oxygen-rich blood into your body, while the right side collects blood that's low in oxygen from your veins and sends it to your lungs to collect oxygen, after which it returns to the left side.

If you have left-sided heart failure, it means your heart is not pumping enough blood out to your body. Your heart may pump less efficiently when you're doing physical activity or feeling stressed.

Two types of heart failure can affect the left side of the heart: systolic and diastolic. The diagnosis depends on how well your heart can pump blood.

If you have systolic heart failure, it means your heart does not contract effectively with each heartbeat. If you have diastolic heart failure, it means your heart isn't able to relax normally between beats.

Both types of left-sided heart failure can lead to right-sided heart failure. Right-sided heart failure happens when the right ventricle functions poorly due to poor contraction or high pressure in the right side of the heart.

When it comes to diagnosing and managing these two types of heart failure, there are some similarities and some differences. Read on to find out what you need to know about systolic and diastolic heart failure.

If you have systolic or diastolic heart failure, you may experience symptoms such as shortness of breath after routine physical activity. Depending on the function of your heart, actions like climbing stairs or walking a short distance may cause these symptoms.

Symptoms of left-sided heart failure can include:

  • shortness of breath or trouble breathing
  • fatigue, even after rest
  • weakness
  • clear, frothy cough
  • inability to sleep lying flat
  • confusion
  • decrease in the amount of urine
  • not eating enough
  • feeling full early
  • weight gain
  • lower leg or stomach swelling
  • However, in the early stages of heart failure, you may not have any symptoms.

    Doctors diagnose heart failure clinically at a patient's bedside. The diagnosis is confirmed based on the results from imaging tests, symptoms, and other lab tests, such as blood tests.

    If doctors suspect you have heart failure, they may perform tests that can include:

  • Echocardiogram (EKG). This test shows the electrical pulse of the heart and can determine if arrythmias are present which can cause heart failure.
  • Transthoracic echocardiogram (TTE). This ultrasound imaging test assesses the structure of the heart and determines ejection fraction (pumping ability of the heart), chamber size, heart valve function, and more.
  • Cardiac computed tomography (CCT) scan. This imaging test takes X-ray images of the heart.
  • Blood tests, such as natriuretic peptide tests. These tests can help determine the amount of stretch on heart walls and can indicate HF. Also blood tests can assess for causes of heart failure such as thyroid dysfunction, anemias, etc.
  • Electrolyte panel. This can show potassium, sodium, and magnesium levels to determine the cause of your heart issue.
  • Cardiac catheterization. In this procedure, doctors insert a thin tube into a blood vessel leading to the heart to visualize the coronary arteries (arteries surrounding the heart) and assess for blockages or coronary artery disease which can be intervened upon with percutaneous intervention (such as angioplasty and stenting).
  • Systolic heart failure diagnosis

    Systolic heart failure happens when the left ventricle of your heart cannot contract completely. That means your heart will not pump forcefully enough to move your blood throughout your body in an efficient way.

    It's also called heart failure with reduced ejection fraction (HFrEF).

    Ejection fraction (EF) is a measurement of how much blood leaves a heart ventricle every time it pumps.

    Doctors determine your EF as a percentage with an imaging test such as an echocardiogram. Between 50 and 70 percent EF is the typical range, according to the American Heart Association (AHA). It's still possible to have other types of heart failure, even if your EF is within that range.

    If your EF is under 40 percent, you may have reduced ejection fraction or systolic heart failure.

    Diastolic heart failure diagnosis

    Diastolic heart failure occurs when your left ventricle can no longer relax between heartbeats because the tissues have become stiff. When your heart cannot fully relax, it won't fill up again with blood before the next beat.

    This type is also called heart failure with preserved ejection fraction (HFpEF).

    For this type, your doctor may order an imaging test on your heart and determine that your EF looks fine.

    Your doctor will then consider whether you have other symptoms of heart failure and if there's evidence from other tests that your heart is not functioning properly. If those criteria are met, you may be diagnosed with diastolic heart failure.

    This type of heart failure most often affects older people and also affects more females than males. It typically occurs alongside other types of heart disease and other non-heart-related conditions such as cancer and lung disease.

    Having high blood pressure, also called hypertension, is one of the most important risk factors. Another important risk factor is untreated sleep apnea.

    There are different medications available to treat systolic heart failure. These can include:

  • beta-blockers (BBs)
  • angiotensin receptor-neprilysin inhibitors (ARNI)
  • angiotensin converting enzyme (ACE) inhibitors
  • angiotensin receptor blockers (ARBs)
  • mineralocorticoid receptor antagonists (MRAs)
  • sodium-glucose co-transporter 2 (SGLT2) inhibitors
  • diuretics
  • digoxin
  • hydralazine
  • isosorbide dinitrate
  • Standard treatment can involve a combination of these medications, since each class of medication targets a different mechanism of heart failure.

    A typical treatment regimen can include: ARNI, ARB, or ACE I along with a beta-blocker and an MRA. Diuretics may also be used for people who continue to have problems with urine retention despite other medical treatments and while following a low salt diet.

    There is new evidence that SGLT2, originally a diabetes medication, can reduce the likelihood of death and re-hospitalization. It is now a standard part of heart failure treatment.

    A review published in 2017 looked at 57 previous trials involving combination treatments. It found that people who took a combination of ACE inhibitors, BBs, and MRAs had a 56 percent reduced risk of death from systolic heart failure, compared with people who took a placebo.

    People who took a combination of ARN inhibitors, BBs, and MRAs had a 63 percent reduced death rate compared with those who took a placebo.

    Doctors may treat diastolic heart failure using many of the same medications that are options for systolic heart failure.

    In general, the main approaches to treating diastolic heart failure with medication include:

  • Medications to reduce fluid buildup. Diuretics, sometimes called "fluid pills," help your body get rid of excess fluid.
  • Medications to control other conditions. Treatment may focus on managing conditions, most importantly, high blood pressure, which can have a big effect on diastolic heart failure.
  • SGLT2 inhibitors. New evidence suggests there may be a role for SGLT2 inhibitors in diastolic heart failure.
  • Cardiac rehabilitation program

    Doctors may also recommend adopting a heart-healthy lifestyle as part of a cardiac rehabilitation program.

    Recommendations can include:

  • treating other health conditions like blood pressure, heart rate, and anemia
  • performing regular physical activity, depending on how serious your heart failure is
  • reducing salt intake
  • getting quality sleep, including treating any sleep disorders such as sleep apnea
  • achieving and maintaining a moderate weight
  • avoiding or limiting alcohol intake
  • if you smoke, considering quitting
  • reducing or managing stress
  • Implanted devices

    For some people with left-sided heart failure, a device that is surgically implanted improves heart function. Types of devices can include:

  • Implantable cardioverter defibrillator (ICD). If you have systolic heart failure, this device gives your heart a shock when your left ventricle beats too fast. This helps your heart beat properly again.
  • Cardiac resynchronization therapy (CRT). This is a special pacemaker that aids in making the ventricles of your heart contract in a coordinated and organized fashion.
  • Left ventricular assist device (LVAD). This pump-like device is often called a "bridge to transplant." It helps the left ventricle do its job when it's no longer working well, and it can help you while you wait to get a heart transplant.
  • Surgery

    In some cases, surgery may be recommended to treat left-sided heart failure. The two main types of surgery can include:

  • Corrective surgery. If a physical heart problem is causing heart failure or making it worse, you may get surgery to fix it. Examples include a coronary artery bypass, which reroutes blood around a blocked artery, or a valve replacement surgery, which corrects a valve that is not working properly.
  • Transplant. If heart failure progresses to a very serious state, you might need a new heart from a donor. After this surgery, you'll have to take medication so your body does not reject the new heart.
  • Systolic and diastolic heart failure both affect the left side of the heart. The left side of the heart is in charge of pumping oxygen-rich blood to the body. Having left-ventricle heart failure means that your heart is not able to efficiently pump all the blood that your body needs.

    This can cause symptoms such as shortness of breath, fatigue, and weakness.

    Doctors can diagnose left-ventricle heart failure as systolic, which means the heart is unable to contract well during heartbeats, or diastolic, which means the heart is unable to relax between heartbeats.

    Both types of heart failure have treatment options, ranging from medication and adopting a heart-healthy lifestyle to implanted devices, surgery, and transplantation.

    A primary care doctor provides overall healthcare and is your main point of contact for health concerns. They can refer you to a cardiologist, who specializes in heart disease.

    A cardiologist may order tests to monitor your condition and recommend medication, certain procedures, surgery, or lifestyle changes. Both doctors often work with nurses and physician assistants.

    A cardiac surgeon may perform coronary bypass surgery, heart valve repair, or other operations to treat underlying causes of heart failure. They may implant a device to help your heart work. Rarely, they may do a heart transplant. Their team may include nurses and physician assistants.

    Cardiac rehabilitation includes lifestyle education, physical exercises, and psychosocial support. It can help strengthen your heart, improve your well-being, and reduce your risk of future heart problems. Your team may include nurses, occupational therapists, and physical therapists.

    A balanced diet protects your heart and may help you lose weight. A registered dietitian can help you develop a sustainable, heart-healthy diet. You may need to adjust your intake of calories, saturated fat, sodium, or fluids.

    Tobacco, alcohol, and other drugs can damage your heart and blood vessels. A smoking cessation or substance use counselor can help you stop using these substances if you find it hard to quit. They may prescribe medication and counseling.

    Heart disease raises the risk of anxiety, depression, and post-traumatic stress disorder (PTSD), which can affect heart health.

    A psychologist, clinical social worker, or licensed counselor may help treat mental health conditions with psychotherapy. A psychiatrist can prescribe medication if needed. Social workers can connect you with support services and assist with legal, financial, and insurance concerns.

    Palliative care doctors and nurses provide care to ease heart failure symptoms and treatment side effects, such as fatigue and nausea. A palliative care social worker helps you and your family plan for the future. Palliative care may improve quality of life at any stage of heart failure.

    It's common to have questions about medications, especially when they're first prescribed to you. Your pharmacist can help explain medication dosing and timing as well as check for interactions with other prescription drugs, foods, or supplements.


    What Leads To Heart Failure?

    Heart failure can happen when your heart is too weak or too stiff to pump enough blood to the rest of your body. Some health conditions can affect how well your heart works and lead to heart failure.

    CAD happens when a fatty substance called plaque builds up in your arteries (the blood vessels that carry oxygen-rich blood from your heart to the rest of your body). Over time, plaque hardens and your arteries get narrow. An artery clogged with plaque is like a clogged drainpipe -- less blood can squeeze through. This is called atherosclerosis.

    Your heart has to pump harder to push blood through those narrow arteries, and it doesn't get the blood it needs to work as well as it should. Over time, this can make your heart so weak that it leads to heart failure.

    If you have CAD, a piece of the plaque that's built up in your arteries can break off. This can lead to a blood clot. If the clot gets lodged in one of the arteries bringing blood to your heart, it can block the blood flow and you could have a heart attack.

    Without enough oxygen, the part of the heart that's blocked can die. This damage weakens your heart and can lead to heart failure.

    Blood pressure is the force of blood as your heart pumps it through your arteries. When the blood pushes against your artery walls with more force than usual, you have high blood pressure. This makes your heart work harder to push blood through your body, and that extra work makes your heart bigger and weaker. High blood pressure that's not managed well can double or triple your chances of heart failure.

    The hormone insulin normally moves sugar from your bloodstream into your cells, where it's used for energy or stored for later. When you have diabetes, your body doesn't make enough insulin or doesn't use insulin well enough. This can leave too much sugar in your blood (high blood sugar).

    High blood sugar damages arteries and weakens your heart. That can lead to heart failure. People who have diabetes are also more likely to have high blood pressure and atherosclerosis.

    This is when your breathing pauses over and over again while you sleep. Each time you stop breathing, your brain jolts you awake to get it restarted. It may be linked to atrial fibrillation (a quivering or irregular heartbeat) and high blood pressure in your lungs, which can lead to heart failure.

    More than one-third of Americans are obese. That means the ratio of their weight to their height, known as body mass index or BMI, is 30 or higher.

    Extra weight puts more strain on your heart. Being obese also makes you more likely to have diseases linked to heart failure, such as high blood pressure, diabetes, or sleep apnea.

    This disease damages your heart muscle and makes it so weak it can't pump blood like it should. Cardiomyopathy can run in families, or it can be caused by coronary artery disease, a virus, or another condition.

    Four valves control the flow of blood into and out of your heart. They keep blood from flowing backward. If you have heart valve disease, at least one of these valves doesn't work right. The problem can start when you're born, or it can be caused by something that damages your heart, like a heart attack or an infection.

    When a valve doesn't open or shut the way it should, your heart has to work harder to pump blood. A valve problem that isn't treated can lead to heart failure.

    Your heart usually beats in a regular lub-dub pattern. The upper chambers squeeze, and then the lower chambers squeeze. When you have an irregular heart rhythm, your heart beats too quickly, too slowly, or out of rhythm.

    If your heart is off its beat for too long, it won't pump enough blood. This can eventually lead to heart failure.

    One or two drinks a day might be good for your heart, but more than that can lead to obesity, high blood pressure, and heart failure.

    Drugs like cocaine, amphetamines, and ecstasy (MDMA) ramp up your heart rate and raise your blood pressure. Using these drugs can lead to a heart attack and eventually make your heart fail.

    Smoking also damages your heart and raises your blood pressure. The chemicals in cigarette smoke keep your blood from carrying enough oxygen through your body. That makes your heart work harder. Smoking also narrows your blood vessels and makes your blood more likely to clot.

    Several drugs can lead to heart failure or make it worse, including:


    Normal Blood Pressure Chart By Age

    High blood pressure, also known as hypertension, is defined by systolic readings of at least 130 mmHg and diastolic readings of at least 80 mmHg, according to the Centers for Disease Control and Prevention (CDC). As of 2021, 116 million U.S. Adults have high blood pressure.

    What Causes High Blood Pressure?

    The cause of high blood pressure, or hypertension, is often unknown. It develops over time and often happens as a result of unhealthy lifestyle choices, according to the Centers for Disease Control and Prevention (CDC).

    "Occasionally, some people have hypertension caused by an underlying condition, such as kidney disease, adrenal gland tumors or thyroid disorders," says Dr. Wong. Other conditions like pregnancy, diabetes and obesity can also increase your risk.

    "Some people are susceptible to high blood pressure from certain medications, such as birth control pills, some decongestants and even some over-the-counter pain relievers," says Wong. "Illicit drugs, such as cocaine and amphetamines may also raise blood pressure."

    High blood pressure is extremely common. A 2017 to 2018 survey conducted by the National Center for Health Statistics found 45.5% of U.S. Adults have hypertension .

    High Blood Pressure Symptoms

    High blood pressure is known as "the silent killer" because it typically has no symptoms. In fact, most people don't even realize they have hypertension until their blood pressure is monitored.

    "Symptoms don't develop until the numbers get very high and organs get damaged, often irreversibly," says Dr. Desai.

    If you have severe hypertension, you might notice the below symptoms, some of which were reported by patients in a study in the British Journal of General Practice :

  • Headaches
  • Shortness of breath
  • Nosebleeds
  • Flushing
  • Dizziness
  • Chest pains
  • Visual changes
  • Blood in urine
  • Mood changes
  • Constipation
  • Treatment: How to Lower High Blood Pressure

    "A healthy lifestyle can help prevent some of the damage that can occur with hypertension, as well as help lower blood pressure to some extent," says Dr. Wong. He recommends:

  • Limiting your salt intake to 2.3 grams a day.
  • Completing 150 minutes a week of moderate-intensity aerobic exercise.
  • Limiting your alcohol intake.
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  • Following the Dietary Approaches to Stop Hypertension (DASH) diet, which can help reduce blood pressure, says Dr. Wong. It's a diet high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish and nuts. It's low in sweets, sugar-sweetened beverages and red meats.
  • Managing your stress with practices like meditation.
  • Reducing your total body fat percentage.
  • Appropriately managing associated medical conditions like diabetes.
  • Side Effects of High Blood Pressure

    "Dangers of untreated high blood pressure include stroke, heart attack, heart failure, vision loss, kidney failure, vascular dementia and sexual dysfunction," says Dr. Desai. It's one of the top risk factors for developing atrial fibrillation, which is the most common heart rhythm disorder worldwide and can lead to stroke, heart failure and reduced quality of life.






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