Heart failure with preserved ejection fraction

Last reviewed: 2 Jan 2023
Last updated: 27 Mar 2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • exertional dyspnoea
More key diagnostic factors

Other diagnostic factors

  • orthopnoea
  • paroxysmal nocturnal dyspnoea
  • abdominal fullness
  • rales
  • jugular venous distension
  • hepatojugular reflux
  • congestive hepatomegaly
  • lower extremity oedema
  • laterally displaced apical impulse
  • gallop sounds
Other diagnostic factors

Risk factors

  • hypertension
  • female sex
  • age >70 years
  • obesity
  • coronary artery disease/ischaemia
  • diabetes mellitus
  • chronic kidney disease
  • myocardial and pericardial disorders
  • obstructive sleep apnoea
More risk factors

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • renal function tests
  • liver enzymes
  • B-natriuretic peptide (BNP)/N-terminal prohormone B-natriuretic peptide (NT-pro-BNP)
  • FBC
  • 12-lead ECG
  • CXR
  • Doppler echocardiography
  • tissue Doppler imaging (TDI)
More 1st investigations to order

Investigations to consider

  • cardiac magnetic resonance (CMR) imaging
  • CT angiography
  • radionuclide ventriculography (MUGA scan)
  • stress testing
  • cardiac catheterisation and coronary angiography
More investigations to consider

Treatment algorithm


acute decompensated HFpEF


chronic HFpEF



Gerald Carr-White, PhD, FRCP

Consultant Cardiologist

Guys and St Thomas’ NHS Foundation Trust




GCW has been reimbursed by Pfizer, Astra Zenica, Bayer, Medtronic, St Jude, and Sanofi for attending conferences. He has attended Advisory Boards for Medtronic, St Jude, Novartis, Shire, Sanofi and Servier, and has a joint working venture with Novartis for a community pharmacist post.

Jessica Webb, BM, BCh, MA, MRCP, FHEA

Cardiology Specialist Registrar

Guys and St Thomas’ NHS Foundation Trust




JW declares that she has no competing interests.


Dr Gerald Carr-White and Dr Jessica Webb would like to gratefully acknowledge Dr Gerard Aurigemma, Dr Lokesh Tejwani, Dr Marc E. Del Rosario, and Dr Kul Aggarwal, previous contributors to this topic. GA, LT, MEDR, and KA declare that they have no competing interests.

Peer reviewers

Edward Geltman, MD

Professor of Medicine

Cardiovascular Division

Washington University School of Medicine

St. Louis



EG has lectured for Novartis, Forest, Merck, and Pfizer.

Jerry Murphy, MB, BS, DM, FRCP

Consultant Cardiologist

Darlington Memorial Hospital




Not disclosed.

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