Heart Failure

HF-rEF & HF-pEF

Heart failure with reduced ejection fraction (HF-rEF) = systolic heart failure -> EF<40% -> It is from impaired contractility 

Heart failure with preserved ejection fraction (HF-pEF) = diastolic heart failure. Diagnosis

Three domains: 1. Functional, 2. Morphological, & 3. Biomarkers

HF-pEF is from impaired cardiac relaxation due to ventricular stiffness, resulting in poor cardiac filling and elevated diastolic pressure -> results in fluid overload (like right ventricular failure). It’s a clinical + structural + functional + biomarker diagnosis. You cannot diagnose HFpEF without HF symptoms/signs. Typical:

• Exertional dyspnoea

• Orthopnoea / PND

• Exercise intolerance

• Peripheral oedema

• Recurrent “pulmonary oedema with normal EF”

If asymptomatic → no HFpEF, no matter what the echo shows. Preserved EF (mandatory), Structural heart disease (Left atrial enlargement), + diastolic dysfunction on echo, elevated biomarkers (ProBNP; also be cautious: It can be normal in obesity. Elevated in AF even without HF) - To make diagnosis