Confused about Stiff Heart, Diastolic Heart Failure, or HFpEF?

Nearly half of all patients with heart failure have a normal EF or ejection fraction. EF is a percentage of how much blood the left ventricle pumps out with each contraction. Why is that?

To get some answers, and with Valentine’s Day just around the corner (what better way to celebrate than by learning about your heart), we sat down with Mayo Clinic cardiologist and heart failure specialist, Dr. Farris Timimi. In this video, Dr. Timimi explains the phenomenon of heart failure with preserved ejection fraction or HFpEF.

Do you have heart failure with preserved ejection fraction (sometimes called Stiff Heart or Diastolic Heart Failure)? What limitations have you experienced with a HFpEF diagnosis? What has helped you?

@FarrisTimimi

In general, a good rule of thumb is to exercise at 60% of your aerobic capacity-the easy way to tell is to exercise at a level that you can still speak in a seven word sentence.

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I am new to this conversation and to my diagnosis of Heart Failure with Preserved Ejection Fraction. I came from Florida to Mayo Minnesota and received my diagnosis. Best care at Mayo/MN I have ever received and I have been in the health care field for over 40 years. Before coming to Mayo, I started pulmonary rehab. My cardiologist ordered it because she said my problem was pulmonary, not cardiac. That did not prove to be true, but it was the so helpful because in pulmonary rehab you are closely monitored and told to 'be the turtle', taking your time and doing the exercises correctly. I did all the same exercises I had been doing before, but I did them slower and rested in between. I could do the exercises and weight lifting under supervision and my shortness of breath has been substantially reduced. I now have my home set up like the rehab and slowly stay active. I hope this helps someone as we each need to find what works best for us.

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@FarrisTimimi

There is good data that suggests regular, moderate aerobic activity is helpful for patients with diastolic heart failure.

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Thank you!

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@FarrisTimimi

There is good data that suggests regular, moderate aerobic activity is helpful for patients with diastolic heart failure.

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I do exercise on a regular basis, but cannot do it daily because of the tremendous fatigue that accompanies exercise, @FarrisTimimi. Might this indicate that my heart meds need to be changed or is this typical? I also met with my endocrinologist recently who said that my magnesium level was at the low normal range (1.8) and that it was possible that when I exercise I go below the normal range and that causes muscle fatigue. I suppose that would affect the heart muscle as well? I have no edema.

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@muriel66

Today I heard Dr. Farris Timimi explain "Heart Failure with Preserved Ejection Fraction". This is the state of my heart. I have diastolic dysfunction. The symptom that led me to this diagnosis, at Mayo Clinic, is shortness of breath when walking for one mile. TRIAMTERENE/HCTZ 37.5-25MG CAP was prescribed.
My concern is whether or not exercise harms the heart that has diastolic dysfunction. I am interested in learning the type and amount of exercise that is appropriate for someone in the early stages of diastolic dysfunction. I also wonder if a hard pounding of each beat of the heart, which I have intermittently even when sitting, is related to diastolic dysfunction.
Thank you.
@muriel66

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I’ve been told to exercise 6 days per week. I usually manage 5-6 days and I walk 1 1/2 miles at 3 mph. I can do arm exercises with 3-5 lb. weights but no more than that. Consult with your Dr. first, of course. I was diagnosed 4 years ago and it all began with Afib. The heart pounding i’m not sure about. Hope this helps!!

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@hopeful33250

I do exercise on a regular basis, but cannot do it daily because of the tremendous fatigue that accompanies exercise, @FarrisTimimi. Might this indicate that my heart meds need to be changed or is this typical? I also met with my endocrinologist recently who said that my magnesium level was at the low normal range (1.8) and that it was possible that when I exercise I go below the normal range and that causes muscle fatigue. I suppose that would affect the heart muscle as well? I have no edema.

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I would encourage you to discuss this with your provider.

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Research studies have shown that Entresto may help improve HFpEF. I thought you might be interested in learning more about this clinical trial from Mayo Clinic, which is open for participation: https://clinicaltrials.gov/ct2/show/NCT03506412
The NIH-funded trial will evaluate the the efficacy of Entresto in patients who’ve been diagnosed with a stiff heart.

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Hello All:

Just a note to let you know about a new clinical study at Mayo regarding Heart Failure with Preserved Ejection Fraction. This refers to percutaneous pericardial resection. Here is a link to a Connect discussion that will give you more information, https://connect.mayoclinic.org/discussion/heart-failure-with-preserved-ejection-fraction-hfpef/

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The doctor gave an excellent quick analysis of what HFpEF really means. Unfortunately, he was unable to provide any hope that there will be any relief to fixing this problem in the near future. Although Mayo has just started another clinical trial in this area. I believe at best it will be a Band-Aid. My personal experience with Mayo has been rather disappointing in this area. When they diagnosed me almost 4 years ago, they offered absolutely no relief end it has been like pulling teeth to obtain input from them in trying to help myself. Overwhelmingly, cardiologists in America concentrate on cardiovascular disease and are largely ignorant of heart failure with preserved ejection fraction. Let us hope that Mayo will address this need more aggressively.

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I was in hospital for 6 days with congestive heart failure, and told i have Stiff heart, has anyone been told they have stiff heart

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@susikelley

I was in hospital for 6 days with congestive heart failure, and told i have Stiff heart, has anyone been told they have stiff heart

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Hi @susikelley, you'll notice that I moved your message to this existing discussion about stiff heart. Click VIEW & REPLY to see all posts of the discussion, including from Dr. Timimi, a cardiologist at Mayo Clinic. In this discussion you can also connect with members @harmonybentley @robschweiger @muriel66 @tcokeefe and others.

Susi, are you still in hospital? What rehab or lifestyle changes have been suggested for you?

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@FarrisTimimi

There is good data that suggests regular, moderate aerobic activity is helpful for patients with diastolic heart failure.

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It seems from what I have read that with diastolic dysfunction or early stage heart failure, there is basically nothing that can be done to improve it but that regular exercise like walking can help slow its progression. Is that correct?

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@tcokeefe

It seems from what I have read that with diastolic dysfunction or early stage heart failure, there is basically nothing that can be done to improve it but that regular exercise like walking can help slow its progression. Is that correct?

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@tcokeefe .
Your cardiologist is the best person to ask about the best treatment and/or therapy for diastolic dysfunction. Often an ACE Inhibitor med can be helpful but of course your doctor should make that decision. Do you currently have symptoms?
What treatments has your doctor recommended?

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