Despite increasing incidence of<unk>  effective inroads to therapeutics have been largely unsuccessful. Currently, recommendations for treatment are directed at symptom relief and co-morbid conditions. Frequently this involves administration of diuretics to relieve complications associated with volume overload, such as leg swelling and high blood pressure. Commonly encountered conditions that must be treated for and have independent recommendations for standard of care include atrial fibrillation, coronary artery disease, hypertension, and hyperlipidemia. There are particular factors unique to<unk>  that must be accounted for with therapy. Unfortunately, currently available randomized clinical trials addressing the therapeutic adventure for these conditions in<unk>  present conflicting or limited evidence. Specific aspects of therapeutics should be avoided in<unk>  to prevent the deterioration of the condition. Considerations that are generalizable to<unk><unk>  include avoidance of a fast<unk>  rate, elevations in blood pressure, development of ischemia, and atrial fibrillation. More specific to<unk>  include avoidance of preload reduction. As patients display normal<unk><unk>  but reduced cardiac output they are especially sensitive to changes in preloading and may rapidly display signs of output<unk> . This means administration of diuretics and vasodilators must be monitored carefully.<unk>  and<unk>  represent distinct entities in terms of development and effective therapeutic management. Specifically cardiac resynchronization, administration of beta blockers and angiotensin converting enzyme inhibitors are applied to good effect in<unk>  but are largely ineffective at reducing morbidity and mortality in<unk> . Many of these therapies are effective in reducing the extent of cardiac dilation and increasing<unk><unk>  in<unk>  patients. It is unsurprising they fail to effect improvement in<unk>  patients, given their un-dilated phenotype and relative normal<unk><unk> . Understanding and targeting mechanisms unique to<unk>  are thus essential to the development of therapeutics. Randomized studies on<unk>  patients have shown that exercise improves left ventricular diastolic function, the<unk> 's ability to relax, and is associated with improved aerobic exercise capacity. The benefit patients seem to derive from exercise does not seem to be a direct cardiac effect but rather is due to changes in peripheral vasculature and skeletal muscle, which show abnormalities in<unk>  patients. Patients should be regularly assessed to determine progression of the condition, response to interventions, and need for alteration of therapy. Ability to perform daily tasks, hemodynamic status, kidney function, electrolyte balance, and serum natriuretic peptide levels are important parameters. Behavioral management is important in these patients and it is recommended that individuals with<unk>  avoid alcohol, smoking, and high sodium intake. Pharmacologic therapy Indications Management of<unk>  is primarily dependent on the treatment of symptoms and exacerbating conditions. The role of specific treatments for diastolic dysfunction per se is as yet unclear. Benefit Currently treatment with ACE inhibitors, calcium channel blockers, beta blockers, and angiotensin receptor blockers are employed but do not have a proven benefit in<unk>  patients. Additionally, use of diuretics or other therapies that can alter loading conditions or blood pressure should be used with caution. It is not recommended that patients be treated with phosphodiesterase-5-inhibitors or digoxin. Agents Mineralocorticoid receptor antagonists An antimineralocorticoid is currently recommended for patients with<unk>  who show elevated brain natriuretic peptide levels. Spironolactone is the first member of this medication class and the most frequently employed. Care should be taken to monitor serum potassium levels as well as kidney function, specifically glomerular filtration rate during treatment. Beta blockers Beta blockers play a rather obscure role in<unk>  treatment though there is suggestion of a beneficial role in patient management. Evidence from a meta-analysis demonstrated significant reductions in all cause mortality with beta-blocker therapy, though overall effects were driven largely by small, older trials of patients post-myocardial infarction. Some evidence suggests that vasodilating beta blockers, such as nebivolol, can provide a benefit for patients with<unk><unk>  regardless of<unk><unk> . Additionally, because of the chronotropic perturbation and diminished LV filling seen in<unk>  the bradycardic effect of beta blockers may enable improved filling, reduce myocardial oxygen demand, and lower blood pressure. However, this effect also can contribute to diminished response to exercise demands and can result in an excessive reduction in<unk>  rate. Beta-blockers are the first-line therapy: they lower the<unk>  rate and thus give more time for ventricles to fill. They may also improve survival. There is some evidence that calcium channel blockers may be of benefit in reducing ventricular stiffness. In some cases, (verapamil has the benefit lowering the<unk>  rate). Angiotensin converting enzyme (ACE) inhibitors Likewise, treatment with angiotensin converting enzyme inhibitors, such as enalapril, ramipril, and many others, may be of benefit due to their effect on preventing ventricular remodeling but under control to avoid hypotension. ACE inhibitors do not appear to improve morbidity or mortality associated with<unk>  alone. However, they are important in the management of hypertension, a significant player in the pathophysiology of<unk> . Angiotensin II receptor blockers (ARBs) ARB treatment results in an improvement in diastolic dysfunction and hypertension that is comparable to other anti-hypertensive medication. Diuretics Diuretics can be useful if significant congestion develops, but patients must be monitored because they frequently develop low blood pressure. Experimental The use of a self-expanding device that attaches to the external surface of the left ventricle has been suggested, yet still awaits FDA approval. When the<unk>  muscle squeezes, energy is loaded into the device, which absorbs the energy and releases it to the left ventricle in the diastolic phase. This helps retain muscle elasticity.
Heart failure with preserved ejection fraction
Ischemic cardiomyopathy
Diabetic cardiomyopathy
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Restrictive cardiomyopathy
Alcoholic cardiomyopathy
Amyloid cardiomyopathy