Is heart failure part of aging ?

Heart failure and its symptoms are never part of normal aging , but with age the incidence of Diastolic heart failure increases

There are two types of heart failure – systolic and diastolic.

The more common Systolic heart failure has low Ejection Fraction; weak, dilated and flabby heart.

Diastolic heart failure, more common in elderly, has normal Ejection Fraction; bulky, thick, small heart 

The systolic one has a more dramatic presentation , such as after a heart attack .

The diastolic one has more subtle symptoms , attributed sometimes to age , such as shortness of breath , tiredness , leg swelling

Aging causes stiffness of the heart muscle, predisposing to diastolic heart failure.

In diastolic failure, the muscle of the heart becomes thick, stiff, and cannot relax properly, allowing a minimal blood filling of the heart. A  stiff balloon cannot expand to fill up with air; thus, despite normal strength of balloon’s walls, there is minimal air to be pumped out. 

Because of normal muscle and contraction, diastolic heart failure has normal Ejection Fraction, or EF. 

It manifests with SOB with minimal walking or incline , leg swelling, SOB while sleeping , excessive fatigue, elevated blood pressure with minimal walking 

In contrast, in the more common systolic failure, the muscle is damaged and week, and despite filling up perfect, cannot pump out the blood . The EF is low. This form of heart failure is seen after heart attacks .

Treatment : American Heart Association and American College of Cardiology recommend controlling:

• systolic and diastolic blood pressure, less than 120/80

• leg swelling and lung congestion using diuretics (“water pills”) furosemide , torsemide , bumetadine

• how fast the ventricles beat in people with atrial fibrillation (beta blockers, calcium blockers , digoxin