Heart failure is a condition where the heart is unable to pump blood effectively to meet the body’s needs. However, not all heart failure is the same. There are two primary types of heart failure: systolic and diastolic. Both involve a weakened heart, but they differ in how the heart’s pumping function is impaired.
In this blog, we will explore the differences between systolic and diastolic heart failure, their causes, symptoms, and available treatment options.
What Is Systolic Heart Failure?
Systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF), occurs when the heart’s left ventricle can’t contract forcefully enough to pump blood out to the rest of the body. This means the heart is unable to pump a sufficient amount of blood with each beat.
Key Features of Systolic Heart Failure:
- Ejection Fraction: The heart’s ejection fraction (EF), which measures how much blood the left ventricle pumps out with each contraction, is reduced in systolic heart failure. A normal EF is between 50% and 70%, but in systolic heart failure, it falls below 40%.
- Weak Heart Muscle: The heart muscle is weakened and stretched out, which makes it difficult for the heart to pump blood efficiently.
What Is Diastolic Heart Failure?
Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), occurs when the heart’s left ventricle is unable to relax properly during the filling phase. This means the heart doesn’t fill with enough blood between beats, even though the heart’s pumping ability is preserved.
Key Features of Diastolic Heart Failure:
- Normal Ejection Fraction: Unlike systolic heart failure, the ejection fraction in diastolic heart failure is often normal (above 50%). However, the problem lies in the heart’s ability to fill with blood, not its ability to pump.
- Stiff Heart Muscle: The heart muscle is stiff and less flexible, which prevents the heart from filling with an adequate amount of blood before it pumps.
Differences Between Systolic and Diastolic Heart Failure
While both types of heart failure lead to the heart’s inability to supply the body with enough oxygenated blood, the underlying causes and mechanisms differ significantly.
Differences Between Systolic and Diastolic Heart Failure
- Ejection Fraction:
- Systolic Heart Failure (HFrEF): Reduced (below 40%)
- Diastolic Heart Failure (HFpEF): Preserved (50% or higher)
- Heart Muscle:
- Systolic Heart Failure (HFrEF): Weakened, stretched out, unable to contract effectively
- Diastolic Heart Failure (HFpEF): Stiff, unable to relax and fill with enough blood
- Main Problem:
- Systolic Heart Failure (HFrEF): Difficulty pumping blood out
- Diastolic Heart Failure (HFpEF): Difficulty filling with blood
- Common Causes:
- Systolic Heart Failure (HFrEF): Heart attack, coronary artery disease, cardiomyopathy
- Diastolic Heart Failure (HFpEF): High blood pressure, aging, obesity, diabetes
- Common Symptoms:
- Systolic Heart Failure (HFrEF): Fatigue, shortness of breath, swelling, irregular heartbeat
- Diastolic Heart Failure (HFpEF): Shortness of breath, fatigue, leg swelling, rapid heartbeat
- Treatment Focus:
- Systolic Heart Failure (HFrEF): Improve contraction and reduce heart strain
- Diastolic Heart Failure (HFpEF): Improve relaxation and control blood pressure
Causes of Systolic and Diastolic Heart Failure
Causes of Systolic Heart Failure:
1. Heart Attack (Myocardial Infarction)
- A heart attack can damage the heart muscle, weakening its ability to contract and pump blood effectively.
2. Coronary Artery Disease (CAD)
- CAD restricts blood flow to the heart muscle due to plaque buildup in the coronary arteries, leading to muscle damage over time.
3. Cardiomyopathy
- Diseases of the heart muscle, such as dilated cardiomyopathy, can cause the heart to stretch and weaken.
4. High Blood Pressure (Hypertension)
- Prolonged high blood pressure forces the heart to work harder, eventually weakening the heart muscle.
Indian Context: According to the Indian Heart Association, coronary artery disease is the leading cause of systolic heart failure in India, largely due to high rates of hypertension, diabetes, and high cholesterol .
Causes of Diastolic Heart Failure:
1. High Blood Pressure (Hypertension)
- Hypertension causes the heart muscle to thicken and stiffen, making it harder for the heart to fill with blood.
2. Aging
- As people age, the heart naturally becomes stiffer, which increases the risk of diastolic heart failure.
3. Obesity
- Excess body weight puts extra pressure on the heart and can lead to stiffening of the heart muscle.
4. Diabetes
- Diabetes increases the risk of heart disease and can damage the small blood vessels that supply the heart muscle, contributing to diastolic dysfunction.
Symptoms of Systolic and Diastolic Heart Failure
Both systolic and diastolic heart failure share many symptoms because both conditions result in the heart’s inability to pump blood effectively. However, the way these symptoms develop and their severity may differ.
Common Symptoms:
- Shortness of Breath (Dyspnea): Difficulty breathing, especially during physical activity or when lying flat, is one of the most common symptoms.
- Fatigue: Reduced blood flow means less oxygen reaches the muscles, leading to chronic fatigue and weakness.
- Swelling (Edema): Fluid buildup in the legs, ankles, feet, or abdomen due to poor circulation.
- 4Rapid or Irregular Heartbeat: The heart may beat faster or irregularly as it tries to compensate for its inability to pump blood effectively.
Unique Symptoms:
- Systolic Heart Failure: Patients may feel a weaker pulse and experience more fatigue due to the heart’s inability to contract properly.
- Diastolic Heart Failure: Patients often experience increased blood pressure and may be more prone to shortness of breath due to the stiffened heart muscle.
How Are Systolic and Diastolic Heart Failure Diagnosed?
- Physical Exam: Doctors will check for signs of heart failure such as swelling, abnormal heart sounds, and fluid in the lungs.
- Electrocardiogram (ECG): An ECG records the heart’s electrical activity, helping doctors detect abnormal rhythms and signs of heart muscle damage.
- Echocardiogram: An echocardiogram is one of the most important tools for diagnosing heart failure. It provides detailed images of the heart and helps doctors determine whether the heart is pumping properly (systolic failure) or having trouble relaxing (diastolic failure).
- Blood Tests: Blood tests, such as measuring levels of brain natriuretic peptide (BNP), can help indicate heart failure. Elevated levels suggest the heart is under strain.
Treatments for Systolic and Diastolic Heart Failure
While the treatment goals for both systolic and diastolic heart failure are similar—improving heart function and preventing fluid buildup—specific treatments may vary.
1. Medications
- ACE Inhibitors: Help relax blood vessels and reduce the heart’s workload, commonly used in systolic heart failure.
- Beta-Blockers: Slow down the heart rate, reduce blood pressure, and improve heart function for both types of heart failure.
- Diuretics: Help reduce fluid buildup, which is important for both systolic and diastolic heart failure patients.
- Aldosterone Antagonists: These drugs help prevent fluid retention and may improve heart function.
2. Lifestyle Changes
Adopting heart-healthy habits is crucial for managing both systolic and diastolic heart failure:
- Reduce Salt Intake: Limiting salt can help prevent fluid buildup.
- Exercise Regularly: Gentle activities like walking can improve heart function and reduce symptoms.
- Quit Smoking: Smoking damages blood vessels and worsens heart failure.
3. Surgical Treatments
In more severe cases, surgery may be necessary:
- Coronary Artery Bypass Surgery (CABG): For systolic heart failure caused by coronary artery disease, bypass surgery can restore blood flow to the heart.
- Valve Repair or Replacement: If heart valve problems contribute to heart failure, surgery to repair or replace the valves may be needed.
- Implantable Devices: Devices like pacemakers or implantable cardioverter-defibrillators (ICDs) can help regulate heart rhythms.
Managing and Living with Heart Failure
While heart failure can’t be cured, it can be managed with the right combination of treatments and lifestyle changes. Regular check-ups with your doctor, adhering to your prescribed medications, and maintaining a healthy lifestyle are key to managing both systolic and diastolic heart failure.
Indian Context: In India, the rising rates of hypertension, diabetes, and coronary artery disease mean more people are at risk for both types of heart failure. Public health campaigns that encourage healthier diets and exercise are vital for reducing the burden of heart failure in the country.
In Conclusion
Both systolic and diastolic heart failure affect the heart’s ability to function properly, but they do so in different ways. Systolic heart failure involves a weakened heart that can’t pump blood effectively, while diastolic heart failure occurs when the heart becomes too stiff to fill with blood properly.
By understanding the differences between these two types of heart failure, you can better recognize the symptoms, seek early treatment, and take steps to manage the condition effectively. Whether through medications, lifestyle changes, or surgical interventions, managing heart failure can improve quality of life and slow the progression of the disease.
Key Takeaways:
- Systolic heart failure is characterized by a reduced ability of the heart to pump blood, while diastolic heart failure is defined by the heart’s inability to fill with blood properly.
- Both types share symptoms like shortness of breath, fatigue, and swelling, but the underlying causes differ.
- Treatments include medications, lifestyle changes, and sometimes surgery, depending on the type of heart failure.
- In India, rising rates of hypertension, diabetes, and obesity are leading contributors to both types of heart failure.
Image Suggestions Recap:
1. A diagram comparing systolic and diastolic heart failure, showing how each affects the heart’s ability to pump and fill with blood.
2. A comparison chart highlighting the differences between systolic and diastolic heart failure in terms of ejection fraction, symptoms, and treatment focus.
3. An infographic summarizing the common symptoms of heart failure, including shortness of breath, fatigue, and swelling.
References:
- American Heart Association (AHA): Types of Heart Failure
- Indian Heart Association (IHA): Heart Failure and Its Causes in India
- World Heart Federation (WHF): Global Heart Failure Statistics
- Public Health Foundation of India (PHFI): Hypertension and Heart Disease in India