What does this conclusion mean?
The cardiac cycle consists of contraction and relaxation. An ultrasound doctor evaluates how quickly and with what pressure blood fills the left ventricle and makes a conclusion about its compliance. The first type, or relaxation disorder, is the easiest and most common finding, especially after 50–60 years. More pronounced types indicate increased filling pressure and occur with prolonged hypertension and heart failure. The conclusion itself is a description of the function, and not an independent disease: complaints and accompanying conditions give meaning to it.
- Type 1 - impaired relaxation, often an age-related feature
- More pronounced types - increased filling pressure
- The ejection fraction remains normal
- The size of the left atrium is also assessed
- The conclusion is interpreted together with complaints and pressure
Causes and risk factors
The main culprit is long-term high blood pressure: the muscle thickens, connective tissue grows in it, and it stretches less well. Age, obesity, diabetes mellitus, coronary heart disease and chronic kidney disease all contribute. A combination with atrial fibrillation and sleep apnea is often found, and these conditions mutually worsen each other. Less commonly, the cause is specific myocardial damage, in which the muscle becomes stiff due to the deposition of pathological substances.
- Arterial hypertension
- Age over 60 years
- Obesity and inactivity
- Diabetes mellitus
- Coronary heart disease
- Atrial fibrillation
- Obstructive sleep apnea
Symptoms
Mild dysfunction usually causes no complaints and is detected by chance. When the filling pressure increases, shortness of breath appears during exertion, which was not there before: it is harder to climb stairs, you have to stop. Later, there are night awakenings from lack of air, the need to sleep on high pillows, swelling of the feet and legs in the evening, and rapid fatigue. Patients often explain this by age and excess weight, so they come late. A sudden deterioration is often provoked by a hypertensive crisis, an attack of atrial fibrillation, or excess salt and fluid.
- Shortness of breath on exertion
- Nocturnal shortness of breath, sleeping on high pillows
- Swelling of the legs in the evening
- Fatigue and decreased endurance
- Heart palpitations and interruptions
- Weight gain due to fluid retention
Survey
The main method is echocardiography with assessment of filling parameters, wall thickness, left atrium size and pulmonary artery pressure. For shortness of breath, it is important to determine natriuretic peptide: a normal level makes heart failure unlikely, an elevated level confirms it. Blood pressure must be assessed, including 24-hour monitoring, as well as sugar, lipids, hemoglobin and kidney function. If ischemia is suspected, stress tests are prescribed; for snoring with pauses in breathing, a sleep study is prescribed.
- EchoCG with assessment of diastolic function
- NT-proBNP for shortness of breath
- ECG and Holter monitoring
- ABPM
- Hemoglobin, sugar, lipids, creatinine
- Load tests according to indications
- Sleep study for suspected apnea
Treatment and lifestyle
There is no special drug that restores myocardial relaxation, so treatment is aimed at the causes and at relieving the heart. The greatest effect is provided by stable control of blood pressure, loss of excess weight, treatment of diabetes and sleep apnea, and maintaining the correct rhythm during atrial fibrillation. In case of fluid retention, the doctor selects diuretics, the dose of which cannot be changed independently. Regular moderate aerobic exercise is beneficial - it improves the tolerance of everyday activities. It is important to limit salt and keep a diary of weight and blood pressure.
- Sustained blood pressure control
- Losing weight and walking regularly
- Limiting salt, controlling the amount drunk during edema
- Treatment of diabetes and lipid metabolism disorders
- Sleep apnea treatment
- Rhythm control in atrial fibrillation
- Daily diary of weight, pressure and pulse
