Heart Failure With Preserved Ejection Fraction

Episode overview

Heart failure with preserved ejection fraction, or HFpEF, is a form of heart failure caused primarily by impaired ventricular relaxation and reduced left ventricular compliance despite a preserved ejection fraction. In this episode, Chris and Mars review why a normal ejection fraction does not mean normal cardiac function, the classic HFpEF patient—older adults with hypertension, obesity, diabetes, chronic kidney disease, or atrial fibrillation—the role of concentric left ventricular hypertrophy and diastolic dysfunction, classic symptoms and physical exam findings including the S4, how HFpEF is diagnosed using clinical heart failure plus evidence of elevated filling pressures or diastolic dysfunction, why obesity can lower BNP levels, SGLT2 inhibitors as foundational therapy, loop diuretics for congestion and the importance of blood pressure control, and why HFpEF treatment should not simply copy the HFrEF medication regimen. Episode pearl: Preserved ejection fraction does not mean preserved cardiac function. HFpEF is a filling-pressure problem caused by a stiff, poorly relaxing ventricle.