Diastolic dysfunction occurs as a result of both age-related changes in the CV system as well as certain forms of heart disease. Common among the latter are hypertension, aortic stenosis, hypertrophic cardiomyopathy and myocardial ischemia.

Age-related changes in the cardiovascular system present the greatest challenge to treatment. Tachycardias (e.g., sinus tachycardia, atrial fibrillation) shorten the time for diastolic filling. Loss of atrial contraction in atrial fibrillation further compromises left ventricular filling. In either situation ventricular filling occurs at higher pressures and may result in a suboptimal cardiac output.

Treatment of atrial fibrillation is beyond the scope of this module. In general, one either controls the ventricular rate with digoxin, beta-blocking drugs, or calcium channel blocking drugs, or attempts to restore sinus rhythm. Electrical or chemical cardioversion may be used to return the cardiac rhythm to a sinus rhythm. Although beta-blocking drugs, ACE inhibitors and calcium channel blocking drugs have been advocated to treat the diastolic dysfunction caused only by age-related changes in the cardiovascular system, there is little convincing data that these drugs have beneficial effects other than the effect they may have on slowing the cardiac rate.

Treatment of diastolic dysfunction associated with hypertension or ischemia requires measures to cause regression of left ventricular hypertrophy. ACE inhibitors, calcium channel blocking drugs, diuretics and beta blocking drugs (roughly in that order) can cause ventricular hypertrophy to regress.

For diastolic dysfunction associated with myocardial ischemia, elimination or mitigation of the myocardial ischemia is essential.

Treatment of hypertrophic cardiomyopathy is also beyond the scope of this module. In general, non-interventional approaches are preferred in the elderly. Verapamil is reported to be quite effective in treating hypertrophic cardiomyopathy; inotropic agents such as digoxin are contraindicated.