Heart Failure with Preserved Ejection Fraction (HFpEF) Diagnosis and Management

Clinical Presentation and Diagnosis

• The American College of Cardiology suggests that patients with heart failure with preserved ejection fraction (HFpEF) typically present with symptoms such as dyspnea, fatigue, and signs of congestion, including elevated jugular venous pressure and bilateral ankle edema, which are supported by the patient's risk factor profile, including hypertension, obesity, and rheumatoid arthritis 1, 2
• The European Society of Cardiology recommends an echocardiogram to assess ejection fraction, left ventricular wall thickness, diastolic function parameters, and estimated pulmonary artery pressures, which is essential for diagnosing HFpEF 6, 1, 2
• The American College of Cardiology recommends measuring BNP or NT-proBNP levels, which are expected to be elevated in HFpEF patients, although levels may be lower in HFpEF compared to HFrEF, especially with obesity 1, 3

Differential Diagnosis

• The American Thoracic Society suggests that interstitial lung disease would present with dry cough, crackles on pulmonary exam, and hypoxemia, which is not consistent with the patient's normal pulmonary exam and normal oxygen saturation 4
• The American College of Cardiology recommends considering pulmonary embolism, which typically presents acutely, not with progressive symptoms, and would not explain chronic bilateral ankle edema or elevated JVP 1

Management

• The American College of Cardiology suggests that diuretics, such as loop diuretics, are used for symptomatic relief of congestion in HFpEF patients, and aggressive decongestion with diuretics is particularly important in patients with right-sided involvement 5, 7