Diastolic heart failure. What primary care physicians need to know.

Congestive heart failure (CHF) with normal left ventricular systolic function and abnormal diastolic performance is a common clinical entity. Typically, signs and symptoms are indistinguishable from those of heart failure related to systolic dysfunction. Coronary artery disease, systemic hypertension, and aging are all associated with diastolic CHF. Diagnosis depends on a clinical suspicion of heart failure, followed by assessment of left ventricular systolic performance, which is normal in this condition. Ventricular diastolic performance can be assessed by noninvasive procedures, the most reliable and easily performed of which is echocardiography. General guidelines include searching for precipitants such as ischemia, tachycardia, and loss of atrial-ventricular synchrony. Treatment includes judicious use of nitrates and diuretics to relieve pulmonary congestion. There is no specific therapy to improve left ventricular diastolic function directly. However, calcium channel blockers and beta blockers are beneficial, and there is growing evidence that angiotensin-converting enzyme inhibitors may prove valuable.