HFpEF underlying mechanisms, clinical presentation, diagnostic tools, and treatment approaches
Heart failure is a complex and challenging condition that requires a thorough understanding to provide effective patient care. Among its various types, heart failure with preserved ejection fraction (HFpEF) presents unique diagnostic and management considerations. This blog aims to provide insights into HFpEF, its underlying mechanisms, clinical presentation, diagnostic tools, and treatment approaches.
HFpEF, often referred to as diastolic heart failure, is characterized by the heart’s inability to adequately relax and fill during the diastolic phase of the cardiac cycle, leading to impaired ventricular filling. Unlike heart failure with reduced ejection fraction (HFrEF), where the heart’s pumping capacity is compromised, HFpEF patients have preserved systolic function but encounter difficulties during the relaxation phase.
Diagnosing HFpEF can be challenging due to its non-specific symptoms, which often overlap with other conditions. Common symptoms include fatigue, dyspnea on exertion, and fluid retention. Since these symptoms can be attributed to various disorders, a thorough clinical assessment is crucial. Pay attention to patient history, physical examination findings (e.g., elevated jugular venous pressure, third heart sound), and risk factors like hypertension, obesity, and diabetes.
Accurate diagnosis of HFpEF requires a combination of clinical judgment, imaging modalities, and biomarkers. Echocardiography is a cornerstone in assessing diastolic function, including parameters like E/e’ ratio, left atrial size, and pulmonary vein flow. Natriuretic peptides, particularly B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), are valuable biomarkers for assessing heart failure severity. By definition the Ejection Fraction (EF) is more than 50%
Managing HFpEF involves a multi-faceted approach aimed at relieving symptoms, improving quality of life, and reducing hospitalizations. Lifestyle modifications, such as sodium restriction, fluid management, and weight loss, play a pivotal role. Optimizing comorbid conditions like hypertension, diabetes, and obesity, as these can exacerbate HFpEF. Pharmacological therapies, including diuretics, beta-blockers, and angiotensin receptor-neprilysin inhibitors (ARNIs), may be beneficial.
Effective patient education is paramount in HFpEF management. Encourage patients to adhere to medication regimens, monitor their weight daily, and recognise signs of worsening heart failure, such as increased shortness of breath or sudden weight gain. Emphasize the importance of regular follow-up appointments and lifestyle modifications.
While research on HFpEF continues, emerging therapies offer hope for improved outcomes. Sodium-glucose co-transporter 2 (SGLT2) inhibitors, initially developed for diabetes, have shown promise in reducing heart failure hospitalizations in HFpEF patients. Additionally, ongoing studies are investigating the efficacy of novel medications targeting myocardial fibrosis and vascular dysfunction.
Heart failure with preserved ejection fraction poses diagnostic and management challenges for junior doctors. By understanding its pathophysiology, recognising clinical presentations, utilising diagnostic tools, and employing a comprehensive approach to treatment, healthcare professionals can make a significant impact on the lives of HFpEF patients. Continued research and collaboration will contribute to enhancing our understanding of this condition and improving patient outcomes.