Feature Article

Diastolic heart failure: an approach to diagnosis

Jonathan Hunter, Sandhir Prasad, John J Atherton



Diastolic heart failure, or heart failure with preserved systolic function, can be diagnosed reliably in most cases with a careful history, physical examination, 12-lead ECG, chest x-ray and echocardiogram. If the diagnosis remains uncertain, the patient should be referred.

Key Points

  • The absence of clinical signs does not exclude a diagnosis of heart failure.
  • Echocardiography is the single most useful diagnostic test in patients with heart failure to determine the mechanism and guide management.
  • If an echocardiogram cannot be arranged in a timely manner in a patient with suspected heart failure, measurement of plasma B-type natriuretic peptide may be considered.
  • The diagnosis of heart failure with preserved systolic function (HFPSF) is based on the triad of having symptoms or signs of heart failure, preserved left ventricular (LV) systolic function and evidence of LV diastolic dysfunction.
  • Alternative causes of dyspnoea and exercise intolerance, including lung disease, anaemia and coronary artery disease, should be considered before making a diagnosis of HFPSF.