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What is a "stiff heart" and how do you treat it?

General responses to selected questions from Joel Braunstein, MD, of Johns Hopkins University and Joseph Toscano, MD.

Question:

My heart doctor said I get a stiff heart, resulting in liquid accumulating in my lungs. What is this and how is it to be treated?

Answer:

It sounds like you may have something called "diastolic dysfunction." This describes a condition where the heart muscle becomes stiff. The stiffness prevents the heart from filling itself completely with blood with each heartbeat. The most common cause is high blood pressure, but other diseases can cause the same problem. The stiffness and decreased filling results in a decreased ability of the heart to pump blood to the body. Sometimes, when the heart is stressed, blood coming from the lungs into the left side of the heart gets backed-up. Once it gets backed-up, fluid from the blood leaks from the blood vessels into the lung air sacs causing "fluid in the lungs" or pulmonary edema. The same thing can happen in the legs, causing swelling of the feet, ankles, or lower legs. This overall process is sometimes referred to as "heart failure" or "congestive heart failure."

The treatment includes many kinds of medications to relax the heart muscle and decrease the amount of work it has to do. Some medications (called beta blockers) may actually decrease the stiffness of the heart muscle over time. Those who have problems with fluid build-up benefit from medications called diuretics, which make the kidneys urinate out extra fluid from the lungs or body. If you have high blood pressure, you should try to control this as much as possible with medication and lifestyle changes. This includes avoiding cigarettes, minimizing your salt and alcohol intake, getting regular aerobic exercise (after an OK from your doctor), and losing any excess body weight.

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