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.

Doctors can diagnose left-ventricular 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.

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.

Symptoms of systolic heart failure 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

Doctors determine your EF as a percentage with an imaging test such as an echocardiogram. The typical range is between 50% and 70% EF, according to the American Heart Association (AHA). But 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%, you may have reduced ejection fraction or systolic heart failure.

Diastolic heart failure occurs when your left ventricle can no longer relax between heartbeats because the tissues have become stiff. When your heart can’t 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).

The symptoms of diastolic heart failure are the same as for systolic heart failure. A doctor must conduct tests to determine which type of left-sided heart failure you are experiencing.

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 whether 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.

In systolic heart failure, the muscles of the heart become weak, and the left ventricle can’t contract normally.

In diastolic heart failure, the muscles of the heart become stiff, and the left ventricle can’t relax normally.

Systolic and diastolic heart failure are different types of left-sided heart failure. 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 doesn’t 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.

Diagnosis of left-sided heart failure

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:

  • Electrocardiogram (EKG): This test shows the electrical pulse of the heart and can determine whether arrhythmia is 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).

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.

Medications for systolic heart failure

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 fluid 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’s 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% 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% reduced death rate compared with those who took a placebo.

Medications for diastolic heart failure

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
  • maintaining a moderate weight
  • avoiding or limiting alcohol intake
  • quitting smoking, if applicable
  • 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.


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 doesn’t reject the new heart.

Lifestyle changes

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

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.

Systolic and diastolic heart failure both affect the left side of the heart.

In systolic heart failure, the left ventricle can’t squeeze or contract normally, keeping blood from circulating properly. In diastolic heart failure, the left ventricle can’t relax, preventing blood from filling the heart between beats and causing the blood flow to back up.

The left side of the heart is in charge of pumping oxygen-rich blood to the body. Having left-ventriclular 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.

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.