Systolic vs. Diastolic Heart Failure: What's the Difference?

Two types of heart failure affect the left side of the heart: systolic and diastolic. If you've been diagnosed with left-sided — also called left-ventricle — heart failure, you may want to understand more about what these terms mean.

In general, heart failure is a condition that occurs when your heart isn't pumping efficiently enough to keep you healthy. Your heart may pump even less efficiently when you're doing physical activity or feeling stressed.

If you have systolic heart failure, it means your heart isn't contracting well during heartbeats. If you have diastolic heart failure, it means your heart isn't able to relax normally between beats. Both types of left-sided heart failure can lead to right-sided heart failure.

When it comes to diagnosing and managing these two types of heart failure, there are some similarities and some differences. Read on to find out what you need to know about systolic and diastolic heart failure.

Systolic heart failure happens when the left ventricle of your heart can't contract completely. That means your heart won't pump forcefully enough to move your blood throughout your body in an efficient way.

It's also called heart failure with reduced ejection fraction (HFrEF).

Ejection fraction (EF) is a measurement of how much blood leaves a heart ventricle every time it pumps. The more the heart pumps out, the healthier it is.

Doctors will tell you your EF as a percentage after doing an imaging test, such as an echocardiogram. Between 50 and 70 percent EF is considered normal. (It's still possible to have other types of heart failure, even if your EF is normal.)

If you have an EF of under 40 percent, you have reduced ejection fraction or systolic heart failure.

Diastolic heart failure occurs when your left ventricle can no longer relax between heartbeats because the tissues have become stiff. When your heart can't fully relax, it won't fill up again with blood before the next beat.

This type is also called heart failure with preserved ejection fraction (HFpEF). In this type, your doctor may do an imaging test on your heart and determine that your EF looks fine. Your doctor will then consider whether you have other symptoms of heart failure and if there's evidence that your heart isn't functioning properly. If those criteria are met, you may be diagnosed with diastolic heart failure.

This type of heart failure most often affects older women. It often occurs alongside other types of heart disease and other non-heart conditions such as cancer and lung disease.

There are many medications available to treat systolic heart failure. These include:

• angiotensin converting enzyme (ACE) inhibitors
• angiotensin receptor-neprilysin (ARN) inhibitors
• angiotensin receptor blockers (ARBs)
• beta-blockers (BBs)
• digoxin
• diuretics
• F-channel blockers
• inotropes
• mineralocorticoid receptor antagonists (MRAs)

For some people, a combination of these treatments can be effective.

For example, a medication that combines sacubitril, an ARN inhibitor, and valsartan, an ARB, was designated as 'first-in-class' by the U.S. Food and Drug Administration (FDA) in 2015. The FDA designates a new medication as first-in-class when it's innovative and works in a way that's different from previous options.

A review published in 2017 looked at 57 previous trials involving combination treatments. It found that people who took a combination of ACE inhibitors, BBs, and MRAs had a 56 percent reduced risk of death from systolic heart failure, compared to people who took a placebo. People who took a combination of ARN inhibitors, BBs, and MRAs had a 63 percent reduced death rate, compared to those who took a placebo.

Doctors may treat diastolic heart failure using many of the same medications that are options for systolic heart failure. However, this type of heart failure isn't as well understood or studied. That means doctors don't have the same guidelines for what may be the most effective treatment.

In general, the main approaches to treating diastolic heart failure with medication include:

• Medications to relax or widen blood vessels. These may include ARBs, BBs, calcium channel blockers, or long-acting nitrates. It could also include vasodilators, such as nitroglycerin.
• Medications to reduce fluid build-up. Diuretics, sometimes called 'fluid pills,' help your body get rid of excess fluid.
• Medications to control other conditions. Treatment may focus on managing conditions such as high blood pressure, which can have a big effect on diastolic heart failure.

Implanted devices

For some people with left-sided heart failure, a device that is surgically implanted improves heart function. Types of devices include:

• Implantable cardioverter defibrillator (ICD). If you have heart failure and irregular heartbeats, this gives your heart a shock when your heartbeat is not regular. This helps your heart beat properly again.
• Cardiac resynchronization therapy (CRT). This is a special pacemaker that aids the ventricles of your heart to make them contract normally and in the right rhythm.
• Left ventricular assist device (LVAD). This pump-like device is often called a 'bridge to transplant.' It helps the left ventricle do its job when it's no longer working well, and it can help you while you wait to get a heart transplant.

Surgery

In some cases, surgery is recommended to treat left-sided heart failure. There are two main types of surgery:

• Corrective surgery. If a physical problem with your heart is causing heart failure or making it worse, you may get surgery to fix it. Examples include a coronary artery bypass, which reroutes blood around a blocked artery, and a valve replacement surgery, which corrects a valve that isn't working properly.
• Transplant. If heart failure progresses to a very serious state, you might need a new heart from a donor. After this surgery, you'll have to take medication so your body doesn't reject the new heart.

If you've been diagnosed with heart failure, talk to your doctor about what type of heart failure you have. Understanding the type of heart failure may help you understand your treatment options better. Sticking to your treatment plan and taking your medication as prescribed are the best ways to manage the condition and reduce your risk of complications.