Chronic Heart Failure with Preserved Ejection Fraction (HFpEF)

Introduction

Chronic heart failure with preserved ejection fraction (HFpEF) is a condition where the heart maintains a normal pumping function (ejection fraction ≥50%), but its ability to relax and fill with blood is impaired. This leads to congestion in the lungs and other organs, causing symptoms like breathlessness and fatigue.

Causes and Risk Factors

HFpEF is primarily caused by conditions that lead to stiffening of the heart muscle, such as: - Hypertension (high blood pressure) – chronic pressure overload makes the heart stiffer. - Diabetes mellitus – affects blood vessels and the heart muscle. - Obesity – increases the workload on the heart. - Aging – natural changes in heart structure affect its function. - Chronic kidney disease – fluid balance disturbances contribute to heart dysfunction.

Symptoms

The symptoms of HFpEF are often non-specific but usually include: - Shortness of breath (dyspnea), especially during exertion or when lying flat. - Fatigue and weakness. - Swelling in the legs and ankles (edema). - Frequent urination at night (nocturia).

Diagnosis

The diagnosis of HFpEF involves multiple tests, including: - Echocardiography – assesses ejection fraction and diastolic function. - BNP or NT-proBNP blood test – measures heart stress markers. - Electrocardiogram (ECG) – detects electrical abnormalities. - Cardiac MRI or CT – provides detailed imaging in complex cases.

Treatment Approaches

Treatment focuses on managing symptoms and underlying conditions:

1. Lifestyle Modifications

• Salt restriction to control fluid retention.
• Regular exercise (moderate-intensity aerobic activity).
• Weight management through a heart-healthy diet.
• Smoking cessation and alcohol moderation.

2. Medications

• Diuretics – to manage fluid overload.
• Mineralocorticoid receptor antagonists (MRAs) (e.g., spironolactone) – may improve outcomes.
• SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) – reduce hospitalizations.
• Blood pressure and heart rate control medications (beta-blockers, ACE inhibitors, or ARBs) – indirectly help heart function.

3. Managing Comorbidities

• Diabetes control is essential.
• Hypertension management to reduce heart strain.
• Atrial fibrillation management to ensure proper heart rhythm.

Conclusion

HFpEF is a complex condition requiring a multidisciplinary approach that includes lifestyle changes, medications, and comorbidity management. If you experience symptoms of heart failure, early diagnosis and treatment are crucial for improving quality of life.

Source recommendations

1. American Heart Association Heart Failure Guidelines

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://professional.heart.org/en/guidelines-and-statements
3. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure
4. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx
5. https://www.heart.org/-/media/Files/Professional/Quality-Improvement/Get-With-the-Guidelines/Get-With-The-Guidelines-HF/HF-Awareness-Week-2023/2023New-Heart-Failure-Guidelines-Impact-on-the-Patient-Journey-The-Healthcare-Professional-Perspecti.pdf

2. European Society of Cardiology Guidelines for Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
4. https://academic.oup.com/eurheartj/article/44/37/3627/7246292
5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines