Diastolic Heart Failure vs. Congestive Heart Failure: Key Differences, Symptoms, and Outlook

Understand how diastolic and congestive heart failure differ, what their symptoms are, and what you can do to manage these serious heart conditions.

By Sneha Tete, Integrated MA, Certified Relationship Coach

Created on Sep 25, 2025

Understand how diastolic and congestive heart failure differ, what their symptoms are, and what you can do to manage these serious heart conditions.

Diastolic Heart Failure vs. Congestive Heart Failure: What’s the Difference?

Diastolic heart failure and congestive heart failure (CHF) both refer to chronic cardiac conditions that affect the heart’s ability to pump blood efficiently. However, understanding their differences, symptoms, causes, and treatment is essential for proper management and improved quality of life.

This article explores the distinctions and relationships between diastolic heart failure and congestive heart failure, delving into their mechanisms, presentation, treatments, and long-term outlook.

Comparing Diastolic and Congestive Heart Failure

Diastolic heart failure is a specific type of left-sided heart failure where the heart’s main pumping chamber (the left ventricle) becomes stiff and cannot relax adequately. In contrast, congestive heart failure is a broad, umbrella term for heart failure conditions that lead to fluid buildup (“congestion”) in tissues throughout the body.

Feature	Diastolic Heart Failure	Congestive Heart Failure (CHF)
Definition	Impaired relaxation and filling of the heart, particularly the left ventricle.	General term for heart failure with fluid accumulation in lungs, abdomen, and tissues.
Also Known As	Heart failure with preserved ejection fraction (HFpEF)	Heart failure with symptoms of congestion; encompasses both systolic and diastolic forms
Main Problem	Stiffness of heart muscle prevents normal filling between beats	Heart can’t pump enough blood, leading to fluid backing up into tissues
Blood Ejection	Impaired filling, but ejection fraction is often normal or near-normal	Can be due to impaired filling (diastolic) or impaired contraction (systolic)
Symptoms	Similar to CHF but may progress differently; see below for details	Shortness of breath, swelling, fatigue, fluid retention

Understanding Diastolic Heart Failure

Diastolic heart failure is a subset of heart failure that primarily affects the left side of the heart. In this disorder:

The muscles of the left ventricle stiffen and lose flexibility.
This reduces the ventricle’s ability to fill with blood between each heartbeat, decreasing the overall blood volume pumped out to the body.
The heart must work harder to maintain regular function.
This form of heart failure is also called heart failure with preserved ejection fraction (HFpEF), since the proportion of blood ejected from the heart (measured as the ejection fraction) remains normal or near-normal, even though overall cardiac output is lower.

Common causes of diastolic heart failure include:

Chronic hypertension (high blood pressure)
Left ventricular hypertrophy (thickened heart wall from chronic strain)
Aging-related changes in heart muscle
Coronary artery disease
Diabetes

What is Congestive Heart Failure?

Congestive heart failure refers to any type of heart failure that results in fluid accumulation (congestion) within the lungs, abdomen, liver, or lower extremities. All forms of heart failure can potentially become “congestive”, but the CHF diagnosis is made when fluid buildup causes symptoms such as swelling or shortness of breath.

CHF can result from problems with:

Heart muscle contraction (Systolic heart failure): The left ventricle can’t contract properly, reducing the amount of blood pushed out (also called heart failure with reduced ejection fraction, or HFrEF).
Heart muscle relaxation (Diastolic heart failure): The heart is too stiff to fill but can contract normally (HFpEF).

Key points about CHF:

Fluid accumulation (congestion) causes classic heart failure symptoms.
CHF is a chronic and progressive condition, often worsening over time without treatment.
CHF can result due to right-sided heart failure or biventricular failure, not just left-sided origins.

Where Does Fluid Accumulate in CHF?

Lungs (causing shortness of breath, cough, wheezing)
Abdomen (ascites, discomfort, bloating)
Liver (congestion can lead to liver dysfunction)
Lower body (leg and ankle swelling, weight gain)

Symptoms of Diastolic and Congestive Heart Failure

Both diastolic heart failure and CHF share similar symptoms, since the end result in both is insufficient blood and oxygen supply to the body and fluid backup. However, the severity and onset may differ based on the underlying cause.

Shortness of breath (dyspnea), especially with activity or when lying down
Fatigue and weakness
Swelling (edema) in feet, ankles, or legs
Rapid or irregular heartbeat (palpitations)
Persistent cough or wheezing with white or pink-tinged blood-tinged mucus
Sudden weight gain from fluid retention
Increased need to urinate at night (nocturia)
Swelling or pain in the abdomen (from fluid accumulation)
Loss of appetite and nausea
Difficulty concentrating or reduced alertness

It’s possible to have only mild or subtle symptoms in the early stages of either condition. As heart failure progresses, symptoms typically worsen and become more noticeable.

How Are Diastolic and Congestive Heart Failure Diagnosed?

To distinguish between these types and forms of heart failure, healthcare providers use a combination of the following:

Medical history and physical exam: Assess symptoms such as swelling, shortness of breath, and chronic conditions.
Imaging (like echocardiogram): To measure heart structure, function, and ejection fraction (how much blood is pumped out with each heart beat).
Blood tests: Assess for markers of heart failure and rule out other causes.
Electrocardiogram (ECG): Measures electrical activity for signs of cardiac abnormalities.
Chest X-ray: Identifies fluid in lungs or heart enlargement.

Typically, a preserved ejection fraction in the setting of clinical symptoms suggests diastolic heart failure (HFpEF), while a reduced ejection fraction points toward systolic heart failure (HFrEF).

Treatment Options for Diastolic and Congestive Heart Failure

There is no cure for either diastolic or congestive heart failure, but a range of treatment options exist to control symptoms, slow progression, and improve quality of life.

Medications

Diuretics to reduce excess fluid and swelling
Beta-blockers to control heart rate and blood pressure
ACE inhibitors or ARBs (angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers) to reduce blood pressure and heart workload
Aldosterone antagonists for further fluid removal
Other blood pressure medications as appropriate

Lifestyle Modifications

Dietary changes such as reducing sodium and fluid intake
Weight management to decrease heart strain
Physical activity as tolerated and prescribed by a healthcare provider
Alcohol and tobacco cessation

Monitoring and Follow-Up

Routine monitoring for symptom changes or fluid buildup
Regular medical checkups and medication adjustments as needed

It’s important to note that diastolic heart failure (HFpEF) can be harder to treat than systolic heart failure (HFrEF). Many drugs that improve outcomes in HFrEF aren’t as effective in HFpEF.

Frequently Asked Questions (FAQs)

Is diastolic heart failure the same as congestive heart failure?

No, diastolic heart failure is a type of congestive heart failure. “Congestive heart failure” is a generic term for any condition where the heart cannot pump efficiently, causing fluid buildup. Diastolic heart failure is when the heart struggles to relax and fill fully, even if pumping function is preserved.

Does diastolic heart failure become congestive heart failure?

Yes—diastolic heart failure can lead to symptoms of congestion like leg swelling and shortness of breath, becoming a type of congestive heart failure. Not every case of diastolic heart failure will show classic CHF symptoms in the early stages, though as the condition progresses, congestion is likely to develop.

What is the prognosis for people with diastolic heart failure vs. congestive heart failure?

Prognosis depends on many factors including type, severity, age, and coexisting illnesses. Recent research shows about 50% of people with any heart failure live five or more years after diagnosis, dropping to about 35% after ten years. Diastolic heart failure is often considered more challenging to treat because many medications effective for systolic heart failure aren’t as beneficial for HFpEF.

What are the main complications of untreated heart failure?

Severe fluid accumulation in the lungs or other tissues (pulmonary edema)
Arrhythmias (irregular heartbeat), which can be deadly
Sudden cardiac arrest
Multi-organ dysfunction due to poor blood supply

How can I reduce my risk of developing heart failure?

Manage blood pressure and cholesterol
Control diabetes and other chronic conditions
Maintain a healthy weight
Follow a heart-healthy diet
Limit alcohol intake and do not smoke
Regular exercise suited to your capabilities
See your doctor for routine checkups

Outlook for People with Diastolic Heart Failure vs. Congestive Heart Failure

Heart failure, including both diastolic and congestive subtypes, is a chronic, lifelong condition that demands ongoing medical care. Many people experience periods of stability followed by episodes of worsened symptoms (“exacerbations”) that may require hospitalization.

Key points on prognosis and management:

The average life expectancy is improving thanks to advances in treatment and earlier detection, but heart failure remains a serious illness.
Survival rates fall with disease progression. Roughly half of all patients diagnosed live five or more years; about a third live a decade or more.
People with diastolic (HFpEF) heart failure may have a slightly better immediate survival but often struggle with more symptoms and hospitalizations over time, mainly due to lack of targeted therapies.
Early diagnosis, aggressive management of risk factors, and adherence to medical and lifestyle recommendations are critical to improving quality of life and long-term outcomes.

The Takeaway

While diastolic heart failure and congestive heart failure affect heart function in different ways, both can lead to serious complications and require lifelong management. Recognizing symptoms early, seeking prompt medical advice, and following your health care provider’s recommendations are vital steps for living well with heart failure.

If you notice new or worsening heart-related symptoms, don’t wait until your next checkup — contact your healthcare provider as soon as possible.

References

Author

Sneha TeteBeauty & Lifestyle Writer

Sneha is a relationships and lifestyle writer with a strong foundation in applied linguistics and certified training in relationship coaching. She brings over five years of writing experience to thebridalbox, crafting thoughtful, research-driven content that empowers readers to build healthier relationships, boost emotional well-being, and embrace holistic living.

Read full bio of Sneha Tete