Diastolic heart failure is best described as which of the following?

• A. Reduced EF due to poor contractility
• B. Preserved EF but impaired filling due to stiff ventricles
• C. Reduced EF due to dilated ventricles
• D. Preserved EF with normal filling

Answer: (B)

Diastolic heart failure comes from a ventricle that is stiff and doesn’t relax well, so filling during diastole is impaired. Because the heart’s squeezing (contraction) is still normal, the ejection fraction stays normal or preserved. In other words, you have impaired filling with a preserved EF, which is the hallmark of HF when the problem is diastolic rather than systolic. This contrasts with systolic failure, where poor contraction or dilated ventricles reduce the ejection fraction. A scenario with preserved EF and normal filling wouldn’t explain the diastolic dysfunction and congestion seen in this condition.