When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Heart failure with preserved ejection fraction

Last reviewed: 10 Nov 2024
Last updated: 24 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • exertional dyspnea
Full details

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
Full details

Risk factors

  • hypertension
  • atrial fibrillation (AF)
  • female sex
  • age >70 years
  • obesity
  • coronary artery disease (CAD)/ischemia
  • diabetes mellitus
  • chronic kidney disease (CKD)
  • dyslipidemia
  • exposure to cardiotoxic agents
  • metabolic syndrome or cardiovascular-kidney-metabolic (CKM) syndrome
  • myocardial and pericardial disorders
  • obstructive sleep apnea
Full details

Diagnostic tests

1st tests to order

  • serum electrolytes
  • renal function tests
  • liver enzymes
  • B-natriuretic peptide (BNP)/N-terminal prohormone B-natriuretic peptide (NT-proBNP)
  • CBC and iron studies
  • 12-lead ECG
  • blood glucose
  • thyroid function tests
  • blood lipids
  • CXR
  • transthoracic echocardiography
Full details

Tests to consider

  • cardiac magnetic resonance (CMR) imaging
  • CT angiography
  • radionuclide ventriculography (MUGA scan)
  • stress testing
  • cardiopulmonary exercise testing (CPET)
  • cardiac catheterization and coronary angiography
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Syed Wamique Yusuf, FACC, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas MD Anderson Cancer Center

Houston

TX

Disclosures

SWY declares that he has no competing interests.

Carl Zehner, MD

Assistant Professor of Medicine

Department of Cardiology

University of Texas MD Anderson Cancer Center

Houston

TX

Disclosures

CZ declares that he has no competing interests.

Acknowledgements

Dr Syed Wamique Yusuf and Dr Carl Zehner would like to gratefully acknowledge Dr Gerald Carr-White, Dr Jessica Webb, Dr Gerard Aurigemma, Dr Lokesh Tejwani, Dr Marc E. Del Rosario, and Dr Kul Aggarwal, previous contributors to this topic.

Disclosures

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

  • Heart failure with preserved ejection fraction images
  • Differentials

    • Heart failure with reduced ejection fraction
    • Cardiac amyloidosis
    • Hypertrophic cardiomyopathy (HCM)
    More Differentials
  • Guidelines

    • 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction
    • 2023 Focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
    More Guidelines
  • Patient information

    Heart failure

    Heart failure: how can I help myself?

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer