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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Chronic Diastolic Heart Failure (Heart Failure with Preserved Ejection Fraction - HFpEF)
Introduction
Chronic diastolic heart failure, now commonly referred to as heart failure with preserved ejection fraction (HFpEF), is a condition in which the heart muscle contracts normally but has difficulty relaxing and filling with blood. Unlike systolic heart failure, where the heart's pumping function is impaired, HFpEF is primarily a disorder of diastolic dysfunction.
Causes and Risk Factors
HFpEF is often associated with conditions that lead to stiffening of the heart muscle, including: - Hypertension (high blood pressure) – Chronic high blood pressure leads to thickening of the heart muscle (left ventricular hypertrophy), which reduces its ability to relax properly. - Aging – As people age, the heart muscle naturally becomes stiffer. - Diabetes – High blood sugar contributes to structural and functional changes in the heart. - Obesity – Excess fat can lead to inflammation and increased workload on the heart. - Coronary artery disease – Reduced blood supply can damage heart tissues. - Kidney disease – Fluid overload can worsen heart failure symptoms. - Atrial fibrillation – This irregular heart rhythm can worsen diastolic dysfunction.
Symptoms
Though it may develop gradually, HFpEF can cause significant symptoms, including: - Shortness of breath (especially during exertion or at night while lying down) - Fatigue and weakness - Swelling in the legs, ankles, or abdomen - Rapid or irregular heartbeat - Difficulty exercising
Diagnosis
The diagnosis of HFpEF typically involves: 1. Medical history and physical examination – Assessing risk factors and symptoms. 2. Echocardiogram – Key imaging test to assess heart function and confirm preserved ejection fraction (>50%). 3. BNP (B-type natriuretic peptide) test – Elevated levels suggest heart failure. 4. ECG (Electrocardiogram) – Identifies heart rhythm abnormalities. 5. Cardiac MRI – Provides detailed imaging of heart structure when needed. 6. Stress test or Cardiac catheterization – Sometimes used to assess coronary artery disease or exercise capacity.
Treatment
While no single medication has proven effective in reversing HFpEF, treatment focuses on managing symptoms and underlying causes:
1. Lifestyle Modifications
- Maintain optimal blood pressure.
- Adopt a heart-healthy diet (low sodium, low-fat, high-fiber foods).
- Engage in regular moderate-intensity exercise.
- Manage weight and diabetes.
- Avoid excessive alcohol and smoking.
2. Medications
- Diuretics – Reduce fluid overload and relieve congestion.
- Mineralocorticoid receptor antagonists (e.g., spironolactone) – May provide some benefits.
- SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) – Show promise in improving outcomes.
- Beta-blockers, ACE inhibitors, or ARBs – Used for blood pressure control and overall cardiovascular protection.
3. Managing Comorbidities
Controlling conditions like hypertension, diabetes, and atrial fibrillation is crucial in HFpEF management.
Prognosis
HFpEF is a chronic condition that requires lifelong management. Early diagnosis and proper treatment can significantly improve quality of life and reduce hospitalizations.
Conclusion
HFpEF is a complex and growing health concern. Recognition of symptoms, early diagnosis, risk factor management, and appropriate treatment strategies are fundamental to improving patient outcomes.
Source recommendations
1. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
- https://pubmed.ncbi.nlm.nih.gov/35363499/
- https://www.sciencedirect.com/science/article/pii/S0735109721083959
- https://pubmed.ncbi.nlm.nih.gov/35378257/
- https://professional.heart.org/en/science-news/2022-guideline-for-the-management-of-heart-failure
2. 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
- https://pubmed.ncbi.nlm.nih.gov/34447992/
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
- https://academic.oup.com/eurheartj/article/42/36/3599/6358045
- https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.2333
- https://academic.oup.com/eurheartj/article/44/37/3627/7246292
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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