Diastolic Dysfunction

After my last echocardiogram, I was diagnosed with diastolic dysfunction. Is this something new and how is it treated?

Diastolic dysfunction (DD), in the simplest terms, is a heart that is struggling to fill with blood because the cells lack the energy needed. DD has only been known about for the past two decades, so it is considered "new." Here's a very brief explanation.

There is a law in cardiology called Starling's Law. Starling found that it actually takes more energy for the heart chambers to stretch and fill during the diastole or "resting phase" than during systole, when the heart is generating ATP and contracting to pump blood out. That's why cardiologists worry more about "the bottom number"—the diastolic pressure—than we do about the systolic or "top number." A high diastolic pressure strains the heart more, and we know that eventually it will push up the systolic pressure.

People with high blood pressure are more likely to develop DD, especially women, because in DD the heart muscle has a stiff response to stretching and expanding. The good news for those with DD is that I've seen great success using metabolic cardiology techniques, since the problem is essentially a situation of energy failure. The idea is that the cells need to be fed the right energy substrates to recover. I pray this is eventually realized by my colleagues in mainstream cardiology.

I haven't personally found any outstanding drugs to treat DD. Instead, I refer you to a chapter I wrote on metabolic cardiology in the book Integrative Cardiology (Oxford University Press, 2011), where I discuss the mechanisms behind DD and the treatment with ATP support. As I explain, I have had great success over the years using the "Awesome Foursome"—CoQ10, L-carnitine, magnesium, and D-ribose—with DD patients. I hope metabolic cardiology will be considered the standard care in 10 to 20 years.