Diastolic Dysfunction

i recently went to dr  due to shortness of breath upon mild exertion ..had CT of lungs it was fine , had echo that found "mild diastolic dysfunction and some thickening of the heart " i was not given any numbers.. when i described to the cardiologist that my SOB was often there even at rest and that i had now also developed a dry cough as well as some swelling in my hands and feet ( no pitting though) and chest pains that often came at rest .. he stated the DD was not severe enough for those symptoms and ordered a stress test .. my heart rate was 98  blood pressure was 112/80 when they started the test and quickly .. with in three minutes it was at 150 and i was dizzy, nearly passing out and very very short of breath .. the test came back normal ...so i was given a mild diretic (HCT) and told im fine my heart functions normally but i must have hbp and that is why the mild dd and thickening but im fine just forget it .. well i am still having chest pains and very out of breath upon the slightest exertion and my primary dr dismissed it all as stress... i want to know if even mild DD can cause SOB and if any of it could be causing my chest pains .. and i cant seem to get a clear answer any where.. i have read the dx of diastolic dysfunction is fairly new .. does anyone really know anything about it ? i know what it is .understand its a problem with e filling of the heart and thats due to a stiffening of the lv... what i do not know is how serious it is !? any help will be happily accepted! thank you in advance, Ginger

[kenkeith]

If the stress test was discontinued, it shouldn't be classified as normal.  At most it should be classified as inconclusive. With DD the bottom number of bp test should be higher than normal (I assume the 150 was systole and not diastole pressure!?).  Yes, DD can cause chest pain and SOB.

Diagnosis of diastolic dysfunction or diastolic heart failure remains imprecise. This has made it difficult to conduct clinical trials of treatments for diastolic heart failure. WHAT IT MEANS: In some studies, diastolic dysfunction has been defined as heart failure (heart failure is EF below 29%) with normal systolic   Do you have a normal (systole)left ventricle funcitonality (EF 55-75%)?.Symptoms of heart failue are SOB , chest pain, etc.

If the heart cannot fill with blood easily (due to DD), either the cardiac output becomes diminished or compensation ensues to increase the ventricular diastolic pressure to higher levels. When the left ventricular diastolic pressure is elevated (lower number), venous pressure in the lungs must also become elevated to maintain forward flow. Increased pulmonary venous pressure results in alveolar edema causing the patient to be short of breath and chest pain.

If cardiac output (stroke volume X heart rate for 1 minute) is diminished, the system compensates by an increase in heart rate, kidneys produce more volume (cause edema...treat with diuretic) and the left ventricle dilates (provides stronger contractions...increase stroke volume), etc. If untreated the dilated LV will over compensate causing a loss of contractility and diminished cardiac output.  Shortness of breath and chest pains can be the symptoms.

A major treatment consideration in people with diastolic dysfunction is when pulmonary edema develops. Unlike treatment of pulmonary edema occurring the setting of systolic dysfunction (where the primary problem is poor ventricular pumping as opposed to poor filling), the treatment of pulmonary edema complicating diastolic dysfunction emphasizes heart rate control (i.e. lowering it). Diuretics are often given as well. Your doctor has prescribed a diuretic!  Heart rate control?

[ginger693]

no heart rate control was fgiven at the drug store yesrerday the rate was 125 i wasnt doing anything ..the stress test only went up to 150 it wasnt stopped i made it but was helped off the treadmil and dont remeber even lying down afterward .. passed out? anyway . dr said the the heart functioned normally .. i would think after all the reading im doing he means the EF was normal .. which means at this time i dont have ?HF? but i didnt know the pressures inmy lungs could be high .. he stated that the left ventricle had thickened and my left ventricle was not relaxing well so the pressures were up .. he didnt really define which ones..but he definately said i shouldnt have symptoms from it .. it was too mild.. im pickng up a cpy of the report in the next few days .. i want to see the numbers thanks for your response!! very helpful

[kenkeith]

With DD you can have heart failure and systole function normal.  Heart failure results when there isn't enough oxygen/blood pumped into circulation to meet the oxygen demand

You can look at DD heart failure (same symptoms as systole dysfunction) happens because there is abnormal filling capacity.  Normal filling capacity plus a normal  EF will meet the system's demand, but for instance filling capacity is less than normal, the normal EF will put into circulation something less than a normally filled chamber.  And that amount may be insufficient to meet system's demand for oxygen.  Eventually under this condition the left ventricle systole will become weak and EF will be reduced as well.

[kevk]

Kenkeith has given a good description of diastolic dysfunction.  I have DD and when I let it get out of control it mimics congestive heart failure.  Blood backs up in to the lungs and causes shortness of breath and chest pain.  My doctor started Beta Blockers to help relax the heart and it helped a lot for the chest pain.  When my heart is in the quick fill mode my EF drops.  My EF is some times higher than normal, Blood pressure in the heart gets way to high.

[ginger693]

so i am  dry coughing , short of breath and even waking up at night i think to cough .. and i have chest pains.. no dr seems to really attributed this pain to the DD.. my heart rate stays high .. it actually showed up on the echo sinus tachycardia.. wouldnt i feel a whole lot better if the heart rate were lower? why do you think they didnt treat that ? is there a way to find a dr who has real experience with this ? i feel like they are just brushing me off .. says its stress. and the husband says im causing myself to have high bp and heart rate becasue i wont calm down .. he basically thinks im a hypochondriac now that the dr have brushed this aside even though i told him it is a real thing and it couldd be serious!!.. he said let it go ... no more drs

[kevk]

I have the dry cough and sleep problems also.  First time it got out of control I cut out all salt and reduced fluid intake to 2 liters.  My chest pain was very bad, I couldn`t get to a phone to call for help. My stress test confirmed  all arteries are open but the heart muscle was contracting to hard and crushing the arteries that was causing the bad pain. Within days after starting Metropolol chest pains stopped.
The doc keeps my heart rate down 40-60 BPM, It sure seems to help. I get very anxious when my rate gets around 80 and start getting faint at 100 BPM.  I took xnax for several years to help with the anxious feelings it helped a little.

I have no clue why your doctor would not put you on a beta blocker or something to slow your your heart rate or lower you blood pressure. You can help yourself by trying to stay calm. I do a lot of deep breathing exercises and keep telling myself getting excited will not help anything but make me feel poorly.
If you get a chance you may want to see a heart failure specialist.

[ginger693]

oh thast a great idea  a heart fauliure speciast .. thanks so much .. it has really helped t read your posts i thought i was going crazy and making all this up !! thansk to both you and kevkieth

[ginger693]

i called the dr.. and the nurse said she wanted me to make appt to talk to this dr again .. so i did .. im not sure what to say to him he semed pretty convinced the DD could not cause sob or chest pain .. and didnt seem concerned with the sinus tachycardia i saw in the report.. so even they know my heart rate is too high .. how do i get him to listen and at least try something to lower my heart rate .. he is already treating the hbp with diaretics.. just need to lower the heart rate from all im reading .. oh and some lifestyle changes tooo !

[kevk]

Ask  if he knows what caused the DD ?  If your left ventricle has got thicker from compensating, What is going to keep it from getting thicker and stiffer ? Ask what you can do to improve your symptoms ?
You may want to get a second opinion.
Give your life style changes a chance to work it will take a little time but you should feel a little better. Try not to worry to much that being the hardest part. If I can think of any questions to help you I`ll get back to you.  If you have any questions for me please feel free to e-mail me on this site.
Please let me know how things are going Good Luck !!!
  If it helps I have lived with DD for twenty years.