What is the Difference Between Systolic and Diastolic Dysfunction?

🆚 Go to Comparative Table 🆚

The main difference between systolic and diastolic dysfunction lies in the heart's ability to contract and relax during and between heartbeats, respectively.

Systolic dysfunction occurs when the heart cannot effectively contract with each heartbeat, leading to reduced pumping function. This is also referred to as heart failure with reduced ejection fraction (HFrEF). In contrast, diastolic dysfunction occurs when the heart cannot relax between heartbeats, which can lead to increased pressure within the chambers of the heart and, in turn, increased pressure in the lungs. This is also referred to as heart failure with preserved ejection fraction (HFpEF).

Both types of dysfunction involve the heart's left ventricle and can lead to similar symptoms, such as shortness of breath during daily activities, difficulty breathing when lying down, weight gain with swelling in the feet, legs, ankles, or stomach, and generally feeling tired or weak. However, the treatment of systolic heart failure focuses on medications, while the treatment of diastolic heart failure is more dependent on addressing the underlying disease and its symptoms.

Comparative Table: Systolic vs Diastolic Dysfunction

The main difference between systolic and diastolic dysfunction lies in their respective effects on the heart's pumping and filling capabilities. Here is a table summarizing the differences:

Systolic Dysfunction Diastolic Dysfunction
Characterized by impaired contractility of the heart, leading to reduced ejection of blood during systole (contraction) Characterized by impaired relaxation and/or filling of the heart, leading to decreased blood volume during diastole (relaxation)
Key diagnostic tool: Estimation of global ejection fraction and regional wall motion Diagnosed indirectly by a normal or nearly normal ejection fraction and assessment of Doppler echocardiography
Treatment includes ACE inhibitors, diuretics, and digitalis, with calcium channel blockers usually contraindicated Treatment depends on the underlying disease, with calcium channel blockers, ACE inhibitors, or beta-blockers being first-line drugs; diuretics can be added with increasing symptoms, and digitalis should be avoided except in atrial fibrillation to control heart rate

Both systolic and diastolic dysfunctions can coexist in advanced stages of heart failure.