Diastolic Dysfunction Management

Introduction to Diastolic Dysfunction Treatment

Diuretics should be used judiciously to reduce congestion and elevated filling pressures in diastolic heart failure, but with careful monitoring to avoid hypotension 1, 2
The American College of Cardiology recommends reduction in central blood volume when fluid overload is present as a treatment principle for diastolic dysfunction 3, 1
Excessive diuresis can reduce cardiac output and worsen symptoms in diastolic dysfunction 2

Beta-blockers are recommended to lower heart rate and increase diastolic filling period, which is a primary therapeutic goal 4, 1, 2
ACE inhibitors may improve relaxation and cardiac distensibility directly and have long-term effects through regression of hypertrophy 4, 2
Verapamil-type calcium channel blockers may be used to lower heart rate and increase diastolic period, with some studies showing functional improvement in hypertrophic cardiomyopathy 4, 2

Control of blood pressure is paramount, with aggressive management particularly crucial in diastolic heart failure 3, 1, 2
Control of tachycardia to improve ventricular filling time is essential 3, 1, 2
Alleviation of myocardial ischemia through appropriate interventions is necessary 3, 1

Avoid excessive diuresis, as patients with diastolic dysfunction are prone to hypotension and reduced cardiac output with overly aggressive volume reduction 2
Monitor carefully for hypotension when initiating any diuretic therapy in diastolic dysfunction 2