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Having shortness of breath. Echo showed diastolic heart failure. What medication should be done?

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General & Family Physician
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60 yrs old female presented with shortness of breath since 2 years and easy fatigability, on doing Echo shows- diastolic heart failure? What medication would be the best choice to treat such patient?
Posted Thu, 11 Apr 2013 in Hypertension and Heart Disease
Answered by Dr. Achuo Ascensius 3 hours later

Thanks for the query

The treatment of diastolic heart failure is based on the underlying cause, co-morbidities and however largely remains empiric as very little clinical evidence is available on this.

Beta blockers reduce heart rate and thus permit ventricular filling to occur thus will be effective in patients with atrial fibrillation, ischemia and those with dilated cardiomyopathy.

Calcium channel blockers especially verapamil have been associated with improvement of diastolic heart failure symptoms and prolong exercise time especially in patients with hypertrophic cardiomyopathy.

Guidelines for treatment of patients with diastolic heart failure published in 2005 by the ACC/AHA task force on chronic hypertension laid down four modalities which are;
-control of systolic and diastolic hypertension
-control of ventricular rates in patients with atrial fibrillation
-control of pulmonary congestion
-coronary revascularization in patients with ischemic heart diseases.
However, treatment should be specific and is achieved by the following;
-use of angiotensin converting enzyme inhibitors and salt restriction diuretics such as HCT, furosemide and oral salt restriction to reduce congestive states,
-use of beta blockers or calcium channel blockers to maintain atrial contraction and prevent tarchycardia and also to treat and prevent myocardial ischemia and
-use of antihypertensive drugs (mostly beta blockers and calcium channel blockers) to control hypertension.

Co-morbid diseases such as diabetes, lipid disorders etc have to be treated as well and appropriately. Angiotensin converting enzyme inhibitors is solicited in the case of associated diabetes and could as well help in the case of congestion.

In a nut shell, the treatment of diastolic heart failure is not standardized; it is case specific and may require a combination of drugs including those for co-morbid pathologies.

You might consider, presenting the case to a cardiologist for an examination and subsequent follow up.

Hope I have answered your query. If you do have some clarifications I will be ready to help.

Best regards and hope this helps you.
Above answer was peer-reviewed by
Follow-up: Having shortness of breath. Echo showed diastolic heart failure. What medication should be done? 2 days later
Thanks for the answer.
Answered by Dr. Achuo Ascensius 46 hours later
You are welcome.

Please if you do not have any further queries, you could close the discussion and rate the answer.

Best regards
Above answer was peer-reviewed by
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