Heart failure with preserved ejection fraction

Last reviewed: 17 Apr 2022
Last updated: 27 Mar 2019

Summary

Definition

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

acute decompensated HFpEF

ONGOING

chronic HFpEF

Contributors

Authors

Gerald Carr-White, PhD, FRCP

Consultant Cardiologist

Guys and St Thomas’ NHS Foundation Trust

London

UK

Disclosures

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

London

UK

Disclosures

JW declares that she has no competing interests.

Acknowledgements

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

MO

Disclosures

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

Jerry Murphy, MB, BS, DM, FRCP

Consultant Cardiologist

Darlington Memorial Hospital

Darlington

UK

Disclosures

Not disclosed.

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