Will diastolic dysfunction lead to heart failure?

Question

Hello doctor,

I am a 46-year-old male, six feet tall, and weigh 216 pounds. I have been experiencing balance problems for over a year, which are indicative of some form of sensory ataxia. Additionally, I have compression in the C4-C5 and C5-C6 cervical spine, along with severe sleep apnea. Last year, I experienced breathlessness and chest discomfort, which led to a positive treadmill test (TMT) and an angiogram revealing minor plaques. Since then, I have been prescribed Aspirin 75 mg, Isosorbide Mononitrate 10 mg, Diltiazem 30 mg, and Atorvastatin 10 mg. However, I continue to experience breathlessness, and my chest pain is intermittent. I also feel fatigued.

Recently, I had an electrocardiogram and an echocardiogram. The ECG results were similar to my previous readings, showing T-wave inversion. Last year's echo indicated mild concentric left ventricular hypertrophy (LVH) and mild diastolic dysfunction. My latest echocardiogram reported mild concentric LVH, moderate diastolic dysfunction with increased left ventricular end-diastolic pressure (LVEDP), a dilated left atrium (LA), a sclerosed aortic valve, and mild pulmonary arterial hypertension (PAH) with a pulmonary artery systolic pressure (PASP) of 40 mmHg. I have enclosed the reports for your reference.

Are my symptoms of breathlessness and fatigue due to diastolic dysfunction or related to my sleep apnea? I cannot use CPAP (continuous positive airway pressure) due to body jerks and discomfort. Is this diastolic dysfunction serious, and could it lead to heart failure? My blood pressure typically ranges from 140/80 to 150/80 mmHg. Is there a possibility that the minor blockages in my arteries have worsened? What course of action should I follow now?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed your report (attachments removed to protect the patient’s identity) and made keen observations. Yes, diastolic dysfunction can lead to heart failure; however, we need to identify the underlying causes in your case. Sleep apnea is one contributing factor that needs to be treated. Additionally, you must manage your hypertension more effectively. Weight reduction, along with medication, will help decrease diastolic dysfunction and alleviate most of your symptoms.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Sclerosis of the valve is age-related, so there is no need to worry now, as your pressure across the aortic valve is normal. The treadmill test (TMT) was positive last time, but it was a false positive; therefore, it is likely to be a false positive again. Your history does not suggest exertional angina or the need for angiography, so it is most probable that your sleep apnea and possibly hypertension are contributing to diastolic dysfunction.

If I were to rely solely on a printed report, then yes, increased diastolic dysfunction would be a concern. Diastolic dysfunction can lead to an increase in the size of the left atrium (LA) and elevated pulmonary artery (PA) pressure. It essentially results in heart failure with preserved ejection fraction, leading to increased pressure in the LA and the lungs.

I hope this helps.

Thank you.