Diastolic Heart Failure
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- Опубликовано: 5 сен 2024
- Cardiology video about congestive heart failure, specifically diastolic heart failure or diastolic dysfunction. Educational video for patients and physicians about symptoms, diagnosis, diagnostic testing, and treatment options.
Great information and timely for me. Thanks for making this video!
Thanks a lot. Invaluable information lucidly told.
Appreciate the comment, thank you. With the risk in obesity and as we learn more about diseases like amyloid this is going to be a much more common diagnosis in the coming years and hopefully more research is done both on prevention and treatment
Ive recently been diagnosed with Dys function stage 1. Was put on amlodpine- not overweight dont drink / smoke been veg for 48 years . Im 60.... great video Sir
I assume the diagnosis came from an echo and if really stage 1 you have no symptoms. If the cause of the diastolic dysfunction is high blood pressure (which can happen even if lifestyle is good), then keeping the BP better controlled is exactly what should be done. 2 points: 1, If you notice any puffiness in your feet that can happen with amlodipine so let your doctor know (if so they will likely adjust meds and it will go away), 2, I would repeat an echo in 1 yr to make sure it is not progressing or hopefully improved.
And thank you for the comments :)
And thanyou for your comment - i do get concerned about my constant high resting heart rate always over 90- i get horrendous sweats... no side effects from amlodopine- been on them for 7 months.... great video- ❤
@@skyechambers1968 - sorry for the delay in responding, I missed your reply. amlodipine does not effect heart rate so it won't bring that down. We don't like resting heart rates that high so if your doctor never checked things like thyroid function, anemia, etc, I would ask about those, and if your weight is normal your probably not very out of shape but the more conditioned you are the lower the heart rate usually.
Thank you!
You're welcome - tough disease that as a medical field we are still learning alot more about, both in diagnosis and treatment, so I suspect we'll be looking at this through a completely different lens within a few years
Hoping trials will be over soon on the Sglt2s so that hubby could benefit from them - wishful thinking. Good info here.
1 year late on this reply (as above, I was not monitoring messages, sorry), but there is data for them and they are good so if he is not on an sglt2 it might be appropriate for him.
Hello Doc. Mine is a long story so i will try to abbreviate. Had an nstemi and pulmonary embolism back in October apparently due to a pfo that allowed a clot through. Have had multiple echos and mri and a heart cath. One of my echos says my left atrium was moderately dilated at 43 lavi. My Cardiologist isn’t concerned but i am. Lateral e is 11.3 septal e is 7.6. Lateral e/e is 4.3 septal e/e is 6.3. E/a ratio is 1.4 and e velocity was 48.7.
Any insights on what this looks like?
Sorry for the delay in responding. A few questions/comments. How old are you and what is your body mass index? Do they know where the pulmonary embolus came from (legs, arms, after surgery...). I assume they did what's called a hypercoagulable work-up (ie, look to see if your blood clots more than most people), did they find anything there. Asking these to see what triggered this in the first place. Since you didn't measure it I assume nobody has seen any atrial fibrillation in you either? And if they didn't find an answer as to what triggered all of this did anyone suggest getting a watch or similar to check your rhythm every day?
Clots can either start in the heart or somewhere outside of the heart, if outside or from the right side of the heart those clots end up in the lungs (pulmonary embolus), or if it is small enough and you're 1 of the 20% of people who have a pfo and it happens to go right in that spot at the exact time of the cardiac cycle when there is a tiny crack there it can go through and then out to the body or the outside of the heart (your nstemi). I realize there are alot of 'ifs' there, but I need a little more information to help answer your question.
Your diastolic filling is ok but your indexed left atrial volume of 43 does make it moderately dilated, that in itself really is not a big deal but the larger concerns are in the questions above.
Glad to continue the discussion if you would like
I’ve been diagnosed with diastolic dysfunction and have very low blood pressure is there a way to raise up the blood pressure to a normal range of blood pressure? I have symptoms with chest pain and shortness of breath. So I’m trying to learn more about the condition since I’m under 50 years old. I’ve only discovered after being released from the hospital before getting my results of my echo and so have had to read it myself and learn what I can about it. My blood pressure has been 88/65 roughly give and take.
Nobody wants to be an interesting patient but this is a unique combination of data points. Diastolic dysfunction is most often caused by increased thickness of the heart muscle, that in turn is most often caused but chronically elevated blood pressure or longstanding obesity (which usually goes along with the higher bp). So to have a low bp (which is a good thing to treat diastolic dysfunction) along with that diagnosis raises questions. Please DO NOT post anything you're not comfortable with as this is not private, but what grade diastolic dysfunction (ie, grade 1-4, or mild-severe), what is the thickness of the left ventricle (should be 2 measurements), and is your kidney function normal?
Hi! I am 21, and I have recently been diagnosed with left ventricular diastolic dysfunction impaired relaxation. Up to that, I have not had any blood pressure problems. It has been a month nearly since I started this, at the beginning it was 130/80 but now at the levels of 140/90. The first test I had was in March which showed no abnormalities, the test that I had in May showed this disfunction.
What can be the reasons for it and bp to develop so quickly at this age, and I would love to hear your recommendations and comments please.
Thank you!!
Several questions for you. How did they get this diagnosis? From an echo? And if so there should be 2 numbers on the report, medial and lateral e'. Can you tell me those numbers? Too frequently I see this read incorrectly on echos so that's why I want to make sure the diagnosis is correct. If the e' truly is significantly abnormal I'll have a few follow up questions for you. What is your body mass index and kidney function? And in regards to the blood pressure the average age of onset in the US is 28, but also much more prevalent in African Americans and if your parents have hi blood pressure
@@davidnajman7640 thank you for your reply, unfortunately, i couldn't find those numbers, the only number i am seeing is e/a ratio of 0.9. I am fit, going to gym and having no problem with my kidneys so far. My father side has high blood pressure genetically, but it is sad to find me at this age. I somewhat connect these (both BP and DD) to the recent utterly stressful situations I have had. I am kinda feeling shortness of breath recently as well. My main question is, can I reverse these, mainly diastolic dysfunction impaired relaxation, I am also drinking hawthorn berry tea to keep my BP under control.
Thank you for your time!
A few good and a few bad things. 1. I see diastolic dysfunction mis-diagnosed ALL the time, an E/A ratio of 0.9 is smack in the middle of a normal range, and based on that I really doubt you have diastolic dysfunction (it's actually on the low side and when it's high is diastolic dysfunction). 2. Hawthorn berry really doesn't affect blood pressure, there's no harm but also doesn't really do much. 3. Can you quantify the sodium you take in? This needs to be everything, ie, there is more sodium in the chocolate milkshake and lemonade at McDonalds than in fries, so look at everything you eat AND drink, try to do so every day for a few weeks. You want to be at most under 2,000mg daily, if you are under 1,000 that's even better. If you're over that and you cut down your blood pressure will also come down. Feel free to message me in a few weeks to let me know but hope that helps.
@@davidnajman7640 i try to avoid table salt as much as possible, i live in Caucasian, Azerbaijan, so our diets may be totally different. Generally, I avoid bread, sugar and any fast food, have my eggs in the morning, rice and chicken and different vegetables and fruits during a day. The main concern for now is my shortness of breath that I have developed over a couple weeks.
Thank you for your time again!
No problem at all on the answers, glad to help and that's why I made this youtube. Most of the salt people eat is in the food, not added to it, and especially a sea town be careful with the salt that's already in the food. This will help with the blood pressure. None of this explains your shortness of breath though.
I assume the rest of your echo didn't show anything significant otherwise they would have told you. If the shortness of breath only happens with exertion it would be a good idea to do a stress test. If the shortness of breath happens anytime then it would be a good idea to see a lung doctor because that would be the next step.
i was diagnosed at 28 years old Diastolic dysfunction lll how long do i have??
A few questions for you. How did they get this diagnosis? From an echo? And if so there should be 2 numbers on the report, medial and lateral e'. Can you tell me those numbers? Too frequently I see this read incorrectly on echos so that's why I want to make sure the diagnosis is correct. If the e' truly is significantly abnormal I'll have a few follow up questions for you.
Hi Dr. Should I be concerned with these results of an Echo cardiogram? (Male 35 Years Old) Left Ventricle:
Overall left ventricular ejection fraction is estimated at 60 to 65%. The left ventricular internal cavity size was normal. LV septal wall thickness was normal. LV posterior wall thickness is mildly increased. Global LV systolic function was normal. Spectral Doppler shows Grade 2 (Moderate) pattern of LV diastolic filling. Summary
1. Overall left ventricular ejection fraction is estimated at 60 to 65%.
2. Normal global left ventricular systolic function.
3. (Grade 2) Moderately abnormal left ventricular diastolic filling.
Thank you, sir!
Kamusta po. The easy answer is maybe. There are a few numbers that would be good to know, there should be a measure of septal and posterior wall thickness, there should also be something called tissue doppler (which is often written as e'). Those measurements would help answer the question, if your blood pressure is high, if you have diabetes, or if your body mass index is over 30 those will also effect it. Let me know if you're able to find those numbers
@@davidnajman7640 Hey Dr.,
LV septal wall thickness = normal
LV Posterior wall = thickness mildly increased
LV Diastolic Function
MV peak E: 0.94 m/s
MV peak A: 0.47 m/s
E/A ratio 2.01
LV IVRT: 67 msec
Left Ventricle -
IVSd 2D 0.97 cm
LVPWd 2D 1.18 cm
LVIDd 2D 4.88 cm
LVIDs 2D 3.07 cm
LV FS 2D 37.1%
Blood pressure 130-135/80
Non diabetic
BMI = 23%
5' 10" Height 160lbs
@@filipinostride6647 - Sorry for the delay in responding, I didn't notice you sent more info. Easy answer, I'm not worried about you at all. We look at e' (which they didn't measure and is the more accurate measurement of diastolic function), but your E/A ratio is normal, and the IVRT on the low side essentially excludes diastolic dysfunction. So I question how they came up with putting that on the report, and the only thing not completely normal there is the thickness of the posterior wall (and I would question if that was measured correctly given all of the other normal readings). Perhaps in 2 years repeat the echo, see if there are any changes, but there really aren't any concerns I would have based on your echo.
@@davidnajman7640 Thank you so much!
@@filipinostride6647 - hope to hear from you in 2 years :) and you're welcome
David Najman, can i contact you in voice to discuss what my mom has been diagnosed with recently? Am Haitham, a pharmacist from Egypt
Glad to, email me and we can share contact info: dr.davidnajman@gmail.com
Continued from above msg:
My mothers ECHO also showed MVP with mild MR.
Could her not taking Chlorthalidone twice weekly for 3 months cause her to have diastolic heart failure in 3 months? As her BNP 3 months ago was normal.
@David Najman
Not taking chlorthalidone will not cause diastolic heart failure, but it can cause someone to start retaining fluid. The mvp and mild MR would not be causing this either...
My sister is a dialysis patient and the cardiologist says she is suffering from pulmonary hypertension as the heart muscles have become rigid.she is unable to evfn walk two steps due to breathlessness and leg swelling.could it be diastolic heart failure?no doctor is able to find the cause..
Just based on what you wrote, that likely is what she has. As I tried to explain in the video the heart is a muscle and has to squeeze blood forward, but it also has to relax to actively pull blood back from the body into the heart. A 'rigid' heart is often too stiff to pull fluid back in. A few good questions to ask her cardiologist (they will understand these and should provide answers to her): 1. How bad is her diastolic function. 2. Is the pulmonary hypertension out of proportion to the extent of her left sided cardiac problems. 3. Have secondary causes such as amyloid been considered. 4. Would a right heart cath help both manage meds and find out how much is due to lungs or heart.
I've seen too many patients unfortunately not adequately diagnosed or cared for, we can usually make symptoms alot better so I would get answers to these questions and those answers hopefully will make her much better.
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Thank you!
Just this last spring I was diagnosed with diastolic heart failure. It was only through an angiogram after having an echo and a stress test. The Dr. called it mild. I was put on Entresto for about the last 6 months. I don't feel better, maybe even worse. And it is really expensive even with insurance. Would an sglt2 be appropriate instead? I have an appointment in 2 weeks.
Please don't put any personal/private information here, but what is your ejection fraction on the echo and were there any significant abnormalities with your valves? Entresto is a very good drug for patients with low ejection fractions, and even though it has an indication for what we call heart failure with preserved ejection fraction (diastolic dysfuntion), that data is very sparse as far as if or how much benefit it provides. It is very good at lowering blood pressure, so if your blood pressure was on the low side to start, it likely will make you feel worse. If your symptoms are driven by excess fluid in your body an SGLT2, spironolactone, or other diuretic should improve your symptoms. If your body mass index is over 35 that is most likely what the underlying cause is and getting that down to a normal range will likely resolve the problem. Feel free to send non-private info or follow-up questions and hope you feel better.
Gred 2 distoloc disfocan revars posibbal
Yes, it is possible to improve or even resolve this, but it depends on the cause. If it is due to obesity and weight comes down to a normal range this should improve, the same would be true for blood pressure or certain valve problems as well.
Hi Sir, is it possible that someone has normal systolic (EF 65%) and diastolic function can have heart failure? My wife's Echo is normal but her NT proBNP is 450.
She feels breathless sometimes and there are bigemni and trigemni in ECG.
We are tensed due to this and doctor is unable to predict anything from it. Thanks in advance.
I apologize for the delay in responding as I was not monitoring comments. That proBNP is not bad, and assuming the systolic and diastolic function is reported from an echo it is less likely that she has heart failure. If the breathless feeling occurs more with exertion and she has more ventricular beats (you did not state if it was atrial or ventricular), a good stress test may be best for her. I am monitoring comments more closely so if this did not answer your questions adequately please let me know
@@davidnajman7640Thanks for the reply. Sorry for not clarifying, ECG shows VPC trigeminal. Her breathlessness is not related to exertion, when she feels breathlessness, she feels it even when lying in bed and when she does not have breathlessness, she do not have it even during exertion.
Giving some of her history: She was detected Mild MR Mitral valve during the initial stage of her pregnancy and it increased to Moderate at the 9th month of pregnancy. After delivery, it went again to Mild and started breathlessness. The doctor asked us to do NTPROBNP and on day 1 it was 680, the doctor asked us to repeat the test the very next day, and it was 450. I have consulted a lung doctor, lungs are clear and hyperactive.
Once again apologies on delay, I'm still learning youtube (cardiology is alot easier) and just found a response with new reply category. Thank you for the updated, a bnp of 680 and 450 alone isn't really a concern, but the combination of everything that you wrote does make me a little worried and I would ask her doctor if they feel getting a cardiac MRI would be warranted (I think it would be a good idea based on what you're describing). Sorry again for the 6 month delay...
@@davidnajman7640 thankyou for the reply. Her NTProbnp is now normal without any medicine. Looks like it was elevated due to pregnancy.
Latest ntprobnp is 45.
But still she has breathlessness but her breathlessness is not related to exertion, when she has breathlessness it doesn’t matter if she is walking or lying down.
We checked with lungs doctor also, lungs functioning is also normal.
There are 2 tests that could be helpful to figure it out, the 1st is the MRI as I wrote above, the other would be a cardiopulmonary stress test where we measure both heart and lung function. If you're able to message her doctor I would ask their thoughts of either test. I hope they find an answer and she gets back to normal and you 2 can be normal healthy parents :)