Summary
Definition
History and exam
Key diagnostic factors
- exertional dyspnea
Other diagnostic factors
- orthopnea
- paroxysmal nocturnal dyspnea
- abdominal fullness
- rales
- jugular venous distention
- hepatojugular reflux
- congestive hepatomegaly
- lower extremity edema
- laterally displaced apical impulse
- gallop sounds
Risk factors
- hypertension
- female sex
- age >70 years
- obesity
- coronary artery disease/ischemia
- diabetes mellitus
- chronic kidney disease
- myocardial and pericardial disorders
- obstructive sleep apnea
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)
- CBC
- 12-lead ECG
- CXR
- Doppler echocardiography
- tissue Doppler imaging (TDI)
Investigations to consider
- cardiac magnetic resonance (CMR) imaging
- CT angiography
- radionuclide ventriculography (MUGA scan)
- stress testing
- cardiac catheterization and coronary angiography
Treatment algorithm
acute decompensated HFpEF
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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