2. INTRODUCTION
• Heart failure with preserved ejection fraction (HFPEF)is a clinical syndrome
in which patients have signs and symptoms of hf as the result of high left
ventricular filling pressure despite normal or near normal LV ejection
fraction(LVEF; ≥ to 50percent)
• In a normal heart, the left ventricle squeezes out most, but
not all, of the blood in its chamber. An ejection fraction
of 55% or more is considered normal.
• Abnormalities in the ventricles’ ability to relax and
passively fill up with blood can lead to a decline in
the volume of blood pumped out of the heart to the
body. HFpEF is most common among older adults and
women.
3. SYMPTOMS
• Most of the symptoms of HFpEF result from an accumulation of blood
and fluid in the lungs, veins, and tissues of the body. Symptoms
of HFpEF include:
• Chest pain
• Fatigue
• Weakness
• Shortness of breath, especially on exertion
• Orthopnea, or shortness of breath when lying down
• Exercise intolerance
• Fast or irregular heartbeat
• Peripheral edema, or swelling of the feet, ankle, or legs
• Weight gain
• Nausea
• Persistent coughing or wheezing
4. CAUSES
• If you have HFpEF, your heart muscle can pump
normally, but it is stiff and therefore unable to
relax and fill properly with blood. As you get
older, the heart and blood vessels become less
elastic, increasing your risk of developing HFpEF.
• Chronic medical conditions can damage the heart
and other organ systems of the body. Often, but
not always, people have more than one health
problem that can impair their left ventricle’s
ability to fill properly with blood during
diastole.
5. OTHER CAUSES LIKE
• High blood pressure: Chronic hypertension is one of the most common causes of
diastolic heart failure. High blood pressure over a long period of time means the
heart has to work harder to pump blood through the body. As a result, the heart
gets more muscular and stiffer, which impacts its ability to relax during the
resting stages of the cardiac cycle when the heart fills up with blood.
• Diabetes: High blood sugar levels are toxic to blood vessels and may cause them to
stiffen. Like high blood pressure, the heart muscle can thicken when it has to
work harder against increased pressure.
• Coronary artery disease: Blockages in the heart’s blood vessels allow less blood
to flow through your heart than usual. Very low blood flow to the heart can lead
to ischemia, or death of heart muscle cells, preventing the heart from relaxing
and filling as it normally would.
• Pericardial disease: Fluid around the heart, called pericardial tamponade, or a
thickened outer covering on the heart, called pericardial constriction, can limit
the heart’s ability to fill with blood.
• Obesity: Increased fat padding around the heart results in the heart having to
work harder to pump.
• Obstructive sleep apnea (OSA): OSA is characterized by partial or complete
cessation of breathing during sleep. This leads to a complex set of changes in the
body, including increases in blood pressure, diminished oxygen delivery to the
heart, and increased sympathetic nervous system activity (SNA). As a result of
these changes, there is a mismatch between oxygen supply and demand, which may
predispose you to cardiac ischemia and arrhythmia, left ventricular hypertrophy,
left ventricular enlargement, and both systolic and diastolic heart failure.3
• Other heart conditions: There are several heart conditions that cause the left
6. CLASSIFICATION
• The New York Heart Association’s classification system is the simplest and
most widely used method to gauge symptom severity.
Class I
• No limitations of physical activity
• No heart failure symptoms
Class II
• Mild limitation of physical activity
• Heart failure symptoms with significant exertion; comfortable at rest or
with mild activity
Class III
• Marked limitation of physical activity
• Heart failure symptoms with mild exertion; only comfortable at rest
Class IV
• Discomfort with any activity
• Heart failure symptoms occur at rest
7. TREATMENT
• HFpEF is a progressive condition with no cure, but its progression
can be slowed or halted in many people through aggressive
treatment and lifestyle changes. In most people, heart failure is
a chronic condition that requires lifelong treatment.
• Most treatments are geared toward slowing down the progression of
your heart failure and managing your symptoms.
• The best way to manage diastolic heart failure is to treat its
underlying cause, such as hypertension, diabetes, or coronary
artery disease.
• The efficacy of medication in the treatment of diastolic heart
failure is inconclusive, but diuretics are commonly used to manage
HFpEF symptoms by removing excess fluid from the body. SGLT2
inhibitors may also be recommended, as they've been shown to
reduce the risk of cardiovascular death and hospitalization for
heart failure. Other medications such as the use of angiotensin
receptor blockers, ARN inhibitors, and mineralocorticoid receptor
antagonists (such as spironolactone) may be considered for certain
people to help decrease hospitalizations.
