What Is Stiff Heart Syndrome?

What Is Stiff Heart Syndrome?

A stiff heart develops when the heart muscle thickens in response to high blood pressure. While initially this thickening helps increase pump function to maintain blood flow to the body, eventually, the pump starts to stiffen, and pressure starts to build up in the heart. This change in pressure can lead to shortness of breath and fluid retention both in the lungs and in the legs.

“I liken this to a bodybuilder, who lifts weights and gets very, very strong. But unfortunately, if you ask them to touch their toes, they're really not able to do that, because they're stiff,” said Vijay Rao, MD, PhD, FACC, FASE, FHFSA, director of the heart failure program at Franciscan Health Indianapolis. “The heart can also have that same sort of process where it becomes very thick and strong, but unfortunately it becomes very stiff. And when that happens, the pressure inside the heart starts to build up. Patients develop congested heart syndrome which leads to fluid buildup in their lungs and legs.”

Congestive heart failure affects more than 6 million Americans. Once heart failure occurs, life expectancy is greatly reduced. That’s why it’s important to be aggressive about prevention and managing symptoms of heart failure.

Who Is At Risk For Stiff Heart Syndrome?

Stiff heart syndrome often occurs in adults over the age of 60. Other risk factors for stiff heart syndrome include:

• Being post-menopausal
• Having uncontrolled high blood pressure
• Having significant obesity

“We really need to focus on weight loss in many of our patients because it's a large driver of high blood pressure and stiff heart syndrome,” Dr. Rao said.

What Are Symptoms Of Stiff Heart Syndrome?

Stiff heart syndrome, also known as heart failure with preserved ejection fraction, results in several notable symptoms, including:

• Fatigue
• Reduced exercise ability
• Palpitations (sensation of feeling heartbeat)
• Shortness of breath with activity
• Swelling of the abdomen, legs, ankles or other part of the body
• Trouble breathing while lying flat

Dr. Rao cautions not to dismiss heart failure symptoms as signs as aging.

“Typically, we'll have people sort of chalk that up to, ‘Well, I'm just getting older and I've been more sedentary and, you know, that's why I'm getting short of breath,’” he said. “But, if it's new for you, I would definitely recommend bringing that up with your primary care doctor, because there certainly could be an underlying heart condition behind it.”

How Can I Prevent Stiff Heart Syndrome?

A key way to prevent stiff heart syndrome is knowing and controlling your blood pressure. High blood pressure is often referred to as the “silent killer” as many people have no symptoms until it is too late.

If your blood pressure is running high, it is important to lower it by:

• Adopting a low-salt diet
• Losing weight
• Controlling your blood sugar if you have diabetes or pre-diabetes
• Exercising at least 30 minutes, five days a week
• Reducing alcohol consumption.

If these measures do not lower your blood pressure enough, it is important to talk with your doctor about medications.

“There are so many excellent blood pressure medications and many are well-tolerated and very inexpensive,” Dr. Rao said. “Taking medications if and when you need them can prevent congestive heart in the future.”

How Is Stiff Heart Syndrome Treated?

Recent advances have changed how stiff heart syndrome is treated.

“If you're a patient with reduced pump function, we now understand the mechanisms for why that occurs,” Dr. Rao explained. “So besides opening up blocked arteries so that people don't get damaged heart muscle, we have medications that block a lot of the bad hormones produced by your body when the heart is not pumping properly.”

Medication Options

There are several medications to alleviate some stiff heart syndrome complications. Sacubitril/valsartan, also known as Entresto, has been a breakthrough therapy for patients with reduced heart function, according to Dr. Rao. Another class of medications called SGLT2 inhibitors, originally used to lower blood sugar in patients with diabetes, also have very powerful effects at preventing congestive heart failure. Instead of using sugar or glucose, the heart muscle starts to use free fatty acids for energy. And by doing so, the heart becomes much more efficient.

Wearable Technology For Managing Stiff Heart Syndrome

Wearable technology is also being used as part of the treatment plan for many people with stiff heart syndrome or congestive heart failure.

“There's a lot of evidence and data coming out about wearable devices like the Apple Watch and something called KardiaMobile,” Dr. Rao said. “We're trying to incorporate a lot of this information into our daily work practice. Patients are able to have real-time data to help them in their health.”

For instance, wearable technology allows a patient to get near-instant feedback on the effect of what they eat has on their blood pressure. “When patients get that kind of feedback, it is incredible what sort of behavioral changes can occur,” said Dr. Rao.

Procedures To Treat Stiff Heart Syndrome

In addition to medications, some patients with stiff heart syndrome may benefit from interventional heart procedures.

“It's one of the reasons I'm so amazed by this field, is that sometimes people can have severely leaking heart valves that can lead to congestive heart failure, and we now have ways to replace a valve without open surgery,” Dr. Rao said. “Certainly in certain circumstances, cardiothoracic surgery is still needed, but we are now starting to do more procedures with a catheter, which means many people can go home within one day of receiving a new valve.”