What Is Stiff Heart Syndrome?

Stiff heart syndrome – more accurately called heart failure with preserved ejection fraction (HFpEF) - occurs when the heart muscle becomes thickened and less flexible.  This makes is harder for the hart to relax and fill with blood between beats. 

Although the pumping strength may appear normal, the thickened muscle doesn’t function normally and pressure builds up in the heart.  Over time, this leads to fluid buildup in the lungs and the rest of the body.  

Without treatment, HfpEF can become a serious and potentially life-threatening condition. David Stewart, MD, a cardiologist at Franciscan Health Crown Point, explains what you should know about stiff heart syndrome and HFpEF.

Key Takeaways: HFpEF

• Stiff Heart syndrome, or HFpEF, happens when the heart muscle becomes stiff and cannot fill properly. The heart may still pump normally, but pressure builds up inside the heart.
• Uncontrolled high blood pressure is the leading cause of stiff heart syndrome.
• This leads to shortness of breath, fatigue and swelling.
• Managing risk factors can prevent or slow progression of stiff heart syndrome.

What Causes A Stiff Heart?

The most common cause of HFpEF is long-standing high blood pressure.  Over time, the heart muscle thickens as it works harder to pump against the increased pressure.

At first, this helps the heart keep up.  But eventually, the muscle becomes stiff and cannot relax properly.  This leads to increased pressure inside rhe heaty, which then causes fluid to back iup into the lungs – and late into the legs and abdomen.

Dr. Stewart cautions against dismissing heart failure symptoms as signs of aging.

“Many people think shortness of breath or welling is just part of getting older,” Dr. Stewart said.  “But these can be early signs of heart failure and shouldn’t be ignored.”

Who Is At Risk?

Stiffening of the heart leading to HFpeF is most common in older adults and is associated with several risk factors, including:

• Long-standing high blood pressure
• Obesity
• Diabetes or pre-diabetes
• Atrial fibrillation (irregular heart beat)
• Chronic Kidney Disease
• Female sex (especially after menopausal)

“Focusing on weight loss can have huge effects on preventing heart failure because it’s a large driver of high blood pressure,” Dr. Stewart said.

What Are The Symptoms of HFpEF?

Common symptoms of HFpEF include:

• Shortness of breath, especially with activity
• Reduced exercise tolerance (getting tired more easily)
• Fatigue
• Swelling in the legs, ankles, and abdomen
• Difficulty breathing when lying flat
• Waking up short of breath at night

How Can I Prevent HFpEF?

The most effective way to prevent HFpEF is aggressive control of cardiovascular risk factors – especially high blood pressure. 

Helpful steps include:

• Following a low-sodium (low-salt) diet
• Losing weight if needed
• Getting regular exercise (at least 30 minutes most days)
• Managing blood sugar if you have diabetes or pre-diabetes
• Reducing alcohol intake

If lifestyle changes aren’t enough, your doctor may recommend medications to help control your blood pressure.

“There are so many excellent blood pressure medications on the market.  Many of these are well-tolerated and  inexpensive,” Dr. Stewart said.  “Sometimes even just one blood pressure pill a day can make the difference and prevent heart failure.”

How Is Stiff Heart Syndrome Treated?

Treatment of HFpEF focuses on relieving symptoms and  managing the underlying causes. 

Recent advances have significantly improved outcomes:

• SGLT2 inhibitors reduce heart failure hospitalizations
• Diuretics (“water pills”) help reduce fluid buildup and relieve swelling
• Blood pressure medications help reduce strain on the heart

“A class of medications called SGLT2 inhibitors was originally used to lower blood sugar in patients with diabetes,” said Dr. Stewart, “and it turns out they also have very powerful effects at preventing congestive heart failure.  It also prevents people with heart failure from ending up in the hospital, which is just such a powerful benefit of a medicine.”

In some cases, underlying structural problems – such as significant valve disease – can contribute to HFpEF.  In these cases, minimally invasive procedures (such as transcatheter valve repair or replacement) may improve symptoms and quality of life.

When Should I See a Doctor?

You should seek medical attention if you notice:

• New or worsening shortness of breath
• Swelling in your legs or abdomen
• Fatigue that limits your daily activities

Early diagnosis and treatment can make a significant difference in how you feel – and in your long-term health.