Heart failure is a highly prevalent condition, particularly among elderly adults and women. In diastolic heart failureor heart failure with normal ejection fraction-left ventricular systolic function is preserved. Although diastolic heart failure is clinically and radiographically indistinguishable from systolic heart failure, echocardiography can reveal a preserved ejection fraction with abnormal diastolic function. The present article reviews current medical concepts related to diastolic heart failure for medical practitioners, particularly primary care physicians, who play a vital role in the care of patients with heart failure. Treatment options, focusing on calcium channel blockers and angiotensin receptor blockers, are discussed. With early diagnosis and proper management, the prognosis of diastolic heart failure can be more favorable than that of systolic heart failure. J Am Osteopath Assoc. 2008;108:203-209 I ncreasingly, left ventricular (LV) diastolic dysfunction is being recognized as a pathophysiologic entity which predisposes certain patients to a distinct form of heart failure called diastolic heart failure (DHF)-or heart failure with normal ejection fraction (HFNEF). The term diastolic dysfunction indicates abnormal diastolic distensibility, filling, or LV relaxation, regardless of whether the ejection fraction is preserved or abnormal or whether the patient is symptomatic or asymptomatic. Thus, diastolic dysfunction refers to abnormal mechanical (diastolic) properties of the left ventricle and is present in virtually all patients with heart failure. The terms DHF and HFNEF are used to describe patients with the signs and symptoms of heart failure, a preserved ejection fraction, and LV diastolic dysfunction. Epidemiology Epidemiologic studies have suggested that 30% to 50% of patients with active congestive heart failure (CHF) have adequate LV systolic function. 6-10 Kitzman et al 10 found that 8% of patients older than 65 years have heart failure, 55% of whom have a preserved LV ejection fraction (LVEF). In addition, diastolic dysfunction has been shown to affect elderly women more than any other population subgroup. 6,7, Pathophysiology Pressure-Volume Relationships Studies related to pressure and volume changes during ventricular function provide unique insights into the diastolic, systolic, and overall pumping characteristics of the heart. Although a detailed discussion of such pressure and volume changes is beyond the scope of this article, a brief review of common principles is helpful. Patients with DHF have a preserved ejection fraction despite increased LV diastolic pressure and pulmonary venous pressure. These patients have both increased passive stiffness and abnormal active relaxation of the left ventricle, which may work independently to cause abnormal diastolic physiology
