Definition of HF
“HF is a complex clinical syndrome that results from
any structural or functional impairment of ventricular filling
or ejection of blood.”
Manifestations of HF
The cardinal manifestations of HF are dyspnea and
fatigue, which may limit exercise tolerance, and fluid
retention, which may lead to pulmonary and/or
splanchnic congestion and/or peripheral edema.
Because some patients present without signs
or symptoms of volume overload, the term
“heart failure” is preferred over “congestive
Some patients have exercise intolerance but
little evidence of fluid retention, whereas
others complain primarily of edema, dyspnea,
Of Heart Failure
On the Basis of
HF With Reduced EF (HFrEF)
also referred to as Systolic HF
• HFrEF is defined as the clinical diagnosis of HF
AND EF ≤40%.
• In approximately half of patients with HFrEF,
variable degrees of LV enlargement may
• Coronary artery disease (CAD) with antecedent
myocardial infarction (MI) is the major cause of
HFrEF. Risk factors are Hypertension, Diabetes,
Metabolic syndrome and atherosclerosis.
HF with Preserved EF (HFpEF)
also referred to as Diastolic HF
• Criteria proposed to define the syndrome of
(a) clinical signs or symptoms of HF
(b) evidence of normal or preserved LVEF (≥50%)
(c) evidence of abnormal LV diastolic dysfunction
that can be determined by Doppler
echocardiography or cardiac catheterization
(a) Hypertension is the major causative factor.
a. HFpEF, borderline EF: 41 to 49 %
These patients fall into a borderline or intermediate group.
Their characteristics, treatment patterns, and outcomes
appear similar to those of patients with HFpEF.
b. HFpEF, improved EF: >40%
A subset of patients with HFpEF previously had HFrEF. These
patients with improvement or recovery in EF may be clinically
distinct from those with persistently preserved or reduced EF.
Further research is needed to better characterize these