Causes, treatment for stiff heart

DEAR DR. ROACH >> A friend of mine has been diagnosed with “stiff heart” and has kind of given up because there is no treatment. With all the advances in medicine, isn’t there something that can be done?

— C.L.

DEAR READER >> It’s not always easy to guess what a medical diagnosis might be from a simplified description like this, but my best guess is that your friend has a type of heart condition called “heart failure with preserved ejection fraction” (HFpEF).

The left ventricle, which is the chamber of the heart that provides oxygenated blood to the body, is indeed stiff, requiring high pressures to fully fill the chamber. The damage to the heart in HFpEF can come from many conditions, including high blood pressure, diabetes, obesity, blockages in the arteries, atrial fibrillation, kidney or lung disease, sleep apnea, and just getting old.

Whenever possible, the underlying conditions should be treated. Specific treatment for HFpEF can be frustrating, but medical advances are catching up. New classes of medicines have been shown to improve symptoms.

If a person has volume overload (such as swelling in the legs or lungs), they will need to get lose the fluid with a diuretic. Once the excess fluid is removed, treatment with a sodium-glucose cotransporter-2 (SGLT2) inhibitor and a mineralocorticoid receptor antagonist has been shown to improve symptoms and outcomes.

In people who are obese with HFpEF, the use of semaglutide has been shown to improve their exercise ability and quality of life, and it has just received an indication by the Food and Drug Administration to protect the heart in this situation.

However, there are other possibilities, such as amyloidosis. It has specific treatments depending on the type of amyloidosis, in addition to the treatments mentioned above for heart failure.

Whenever possible, the underlying conditions should be treated.