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The Big Differences Between Systolic and Diastolic Heart Failure

Our hearts beat about 100,000 times each day (maybe more if you enjoy horror movies). Despite being extremely complex, our hearts are exceptionally reliable. So, it’s safe to say, you probably don’t think about your heart very often.

That’s OK most of the time but looking after our heart’s health should be a priority for everyone. According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for both men and women in the U.S. And 8.5% of those deaths, are directly related to heart failure according to the Heart Failure Society of America (HFSA).

Heart failure usually falls into two categories: systolic and diastolic. With systolic heart failure, your heart isn’t contracting well during heartbeats. While diastolic heart failure, by contrast, is when your heart can’t relax normally between beats.

The differences don’t stop there — and the differences are important.

Namit Rohant, MD, a cardiology specialist at Banner – University Medicine North in Tucson, AZ, talked to us about the symptoms of heart failure and the key differences between the two types and their respective treatments.

Symptoms of heart failure

Both conditions involve the heart’s left ventricle, and the symptoms for both may feel very similar if you experience them. Both diastolic and systolic heart failure have the following symptoms:

  • Shortness of breath during daily activities
  • Difficulty breathing when lying down
  • Weight gain with swelling in the feet, legs, ankles or stomach
  • Generally feeling tired or weak

But how you treat systolic and diastolic heart failure can differ quite a bit.

Systolic heart failure

Systolic heart failure, or when your heart struggles to contract during heartbeats, is considered the final manifestation or outcome of several heart conditions, and is also called heart failure with reduced ejection fraction (HFrEF).

Ejection fraction (EF) is a mouthful, for sure. But it’s an important measure. In simple terms, it measures the percentage of blood your heart pushes out with each pump. The more the heart pumps out, the healthier it is. An EF between 50 and 70 is normal. If it’s below 40, then that signals systolic heart failure.

“Over the years, systolic heart failure has had a lot of promise with medical therapy,” Dr. Rohant recalled. He outlined four types of medication that are typically used to treat it:

  • Beta blockers (BB)
  • Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), or angiotensin receptor neprilysin inhibitors (ARNI)
  • Mineralocorticoid receptor antagonists
  • Sodium-glucose transport protein 2 (SGLT2) inhibitors

Dr. Rohant said these medications have been studied in a variety of different trials with diverse patients — and when it comes to systolic heart failure, they’ve been shown to reduce mortality and hospitalizations.

Generally, systolic heart failure is better understood than diastolic heart failure. And advances in treatment mean that more drastic interventions (implants, surgeries, transplants) are incorporated later in the treatment process than they used to be.

Diastolic heart failure

When your left heart ventricle has stiffened and can’t relax between beats, that’s diastolic heart failure. It’s also called heart failure with preserved ejection fraction (HFpEF). People with this condition can have a normal EF— meaning the percentage of available blood that it’s pumping out is normal. But the amount of blood being pumped is less because a heart that’s not relaxing between beats isn’t completely filling up with blood before each beat.

Dr. Rohant explained that many other conditions can sometimes mimic heart failure. So, to determine if a patient’s heart failure is diastolic, doctors will look at things like a patient’s weight, history of hypertension, history of irregular heart rhythm, age, cardiac lab work and some echocardiographic measurements. If these other factors indicate the patient’s heart has stiffened, then the issue may in fact be diastolic.

Unfortunately, the medicines that have proven successful for systolic heart failure haven’t been as successful with diastolic heart failure. So, this condition still has a lot of unknowns. But in general, the main approaches for treating diastolic heart failure with medication include:

  • Medications to relax or widen blood vessels: ARBs, BBs, calcium channel blockers, or long-acting nitrates, as well as vasodilators like nitroglycerin
  • Medications to reduce fluid build-up: i.e. diuretics
  • Medications to control other conditions, like high blood pressure

Getting better (and staying better)

According to Dr. Rohant, patients often think that once they start feeling better, it means they can stop taking meds and practicing healthier lifestyle habits. This just isn’t the case, for both systolic and diastolic heart failure.

“These medications and lifestyle modifications are what allowed them to start feeling better again,” he explained, adding that heart medications can control and treat heart failure, but not cure it outright.

For people with heart conditions, there is plenty of good news. And 80% of cardiovascular disease is preventable, according to the American Heart Association. Early detection and consistent treatment are key. So, if your doctor has prescribed you a certain heart medication, and it’s working, then keep taking it.

For additional information and guidance, speak with your cardiologist or find a health care provider near you by visiting bannerhealth.com.

You may also want to read these related articles, written with help from other Banner Health experts:

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