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Heart failure is a broad term that describes several conditions when the heart has weakened and is no longer efficiently pumping blood to the rest of the body.

In the case of diastolic heart failure, the left ventricle has become stiff and can’t fill with blood during the pauses between heartbeats and does not relax normally. This condition is sometimes called heart failure with preserved ejection fraction.

Recognizing the early symptoms of diastolic heart failure is critical in starting treatment before the heart weakens further. Although heart failure is a serious condition with no current cure, improvements in medications and medical technology have improved the outlook for many people facing this condition.

Heart failure

Heart failure doesn’t mean the heart has stopped beating. It simply means that because of a heart attack or other damage, it is weaker and less efficient than it used to be. The heart still beats, but it can’t pump out the volume of blood to adequately supply all of your organs and other tissues, or it operates at higher pressures to do so.

With lifestyle measures, medications, and procedures to improve blood flow and address any heart valve problems, many people can live with heart failure for a long time.

Diastole vs. systole

To better understand diastolic heart failure, it’s helpful to know the difference between diastole and systole.

With each beat of your heart (systole), the left ventricle (lower left chamber) pumps blood to the body, while the right ventricle (lower right chamber) pumps blood to the lungs to become oxygenated.

At the same time, your right and left atria (upper chambers) are filling with blood. In between beats (diastole), the atria move blood into the ventricles to be ready for the next heartbeat.

Diastolic heart failure

Diastolic heart failure occurs when the left ventricle can’t relax enough to fill with a sufficient amount of blood, or does so at higher pressures. So when the heart beats, a smaller-than-normal amount of blood is pumped out to the body. Over time, organs can suffer from a reduced flow of oxygen- and nutrient-rich blood and higher filling pressures.

Diastolic heart failure is also referred to as heart failure with preserved ejection fraction (HFpEF). Ejection fraction measures how much blood is pumped out of the left ventricle every time the heart muscle contracts.

A healthy heart usually has an ejection fraction of between 50 and 70 percent. HFpEF may be diagnosed with an ejection fraction of 40 to 49 percent. The ejection fraction could be higher in some cases of diastolic heart failure, but in those cases, the left ventricle isn’t filling with as much blood as it normally should.

In the earliest stages of diastolic heart failure, you may not notice any symptoms. But as the condition progresses, some of the following symptoms will likely develop:

These symptoms can vary from mild to moderate at first, but without treatment, they will likely worsen over time.

When to seek medical attention

The early, minor symptoms of diastolic heart failure may not interfere with your ability to carry out your usual activities. But as the condition progresses, you should know the signs that signal you may need an appointment with a healthcare professional. These include:

  • shortness of breath or coughing every time you lie flat
  • irregular heartbeat
  • sudden swelling in the abdomen or lower legs
  • weight gain
  • persistent cough or wheezing with mucus

Chest pain can be a sign of a worsening heart failure, but it can also signal a heart attack and should be treated as a medical emergency. Other symptoms, especially when accompanied by chest pain, that require emergency attention include:

  • sudden shortness of breath
  • coughing up pink or blood-tinged mucus
  • feeling faint
  • sudden, rapid increase in your heart rate
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Diastolic heart failure means the heart muscle has gotten stiff. As with many cardiovascular conditions, advancing age is one of the primary causes of diastolic heart failure. Other common causes and risk factors for diastolic heart failure include:

  • coronary artery disease
  • diabetes
  • obesity
  • aortic stenosis
  • obstructive sleep apnea
  • kidney disease

A 2016 study notes that diastolic heart failure is now the most common form of heart failure. It also suggests that the key to successful treatment is “aggressive management of contributing factors.” That means treating diastolic heart failure also involves proper treatment of any other conditions you may have, as listed above.

More specifically, treating diastolic heart failure usually involves some combination of the following therapies:


The right combination of medications depends on the nature of your heart failure and whether other conditions are present.

A 2021 study found that a sodium–glucose cotransporter 2 inhibitor called empagliflozin reduces the risk of cardiovascular death and hospitalization for people with diastolic heart failure.

A 2020 journal article reported that the diuretic spironolactone, when added to other blood pressure-lowering drugs, improved outcomes for people with diastolic heart failure and resistant hypertension.


Because heart failure can make it difficult to exercise and possibly even dangerous to exert yourself too much, the American Heart Association recommends finding a cardiac rehabilitation program that will teach you the proper way to exercise safely and avoid complications down the road.


If a blocked blood vessel is contributing to your diastolic heart failure, you may benefit from angioplasty. This is a procedure in which a small balloon is inflated in the blocked portion of the artery, opening it wider for improved blood flow. In some cases, a flexible mesh tube called a stent is left in place to help keep the artery open.

If a heart valve issue has caused left ventricle problems, you may be a candidate for heart valve replacement or repair.

Resources for coping with heart failure

Living with heart failure usually means making some changes to your lifestyle. To thrive with heart failure, you need to do more than eat nutritious foods, exercise, and follow your doctor’s other advice. You’ll also need to know the signs that your physical and mental health may be changing due to heart failure.

If you’re a caregiver for someone with heart failure, you should learn about what to expect to prepare you for this role.

The following articles can help you learn more about heart failure and what to expect moving forward:

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Diastolic heart failure is a chronic condition that can be managed with proper treatment and a heart-friendly lifestyle.

A 2020 study notes that the annual mortality rate for the 6 million or so people in the United States with diastolic heart failure is between 8 and 12 percent, with older adults at the upper end of that estimate. Some estimates suggest that about half of the people with heart failure will live for at least 5 years after diagnosis, while about 30 percent live at least 10 years.

It’s important to have your symptoms checked out soon after they appear. Working closely with a healthcare professional after a heart failure diagnosis will give you the best chance at a longer life and a better quality of life.