TREATMENT OPTIONS FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION
Earlier, heart failure was synonymous with a “Systolic or Pump Heart Failure.” However, it has been proven that a heart can fail even when there is a normal pump function. This condition is known as Heart Failure with Preserved Ejection Fraction or HFPEF. The Heart Failure Treatment for the failure due to HFPEF is discussed in this article.
HFPEF
Studies by epidemiologists say that HFPEF is almost half of heart failures. The overall survival rate of people with HFPEF is better when compared to Systolic heart failure. The trials of treatment for HFPEF, unlike the regular heart failures with reduced ejection fraction, have been inconclusive. A novel therapeutic approach is needed to treat HFPEF. Correct diagnosis, recognizing the pattern, physical diagnosis, and the approach to the treatment is needed for people with HFPEF.
DIAGNOSIS
The first and the most crucial step is the correct diagnosis. The following three criteria must be present for HFPEF, though not formally validated yet.
- Clinical symptoms of Heart Failure
- Mild abnormal Left Ventricular systole
- Proof of dysfunction of LV diastolic
HFPEF is diagnosed by the clinical symptoms and ECG or Echocardiography. The preserved ejection fraction is diagnosed through the ECG without any pericardial disease.
It must be kept in mind that diagnosis is dependent on clinical symptoms of heart failure that are nonspecific. Pattern recognition, physical examination including certain tests, and exclusion of diseases must be done methodologically. ECG assists in confirming the diagnosis but is not a conclusive option.
PATTERN RECOGNITION
It is seen that HFPEF majorly affects women in the age group above 65 years with hypertension. Certain cardiovascular symptoms coexist in HFPEF cases. They are:
| S. No | CO EXISTING DISEASE | % Of Cases |
| 1 | Obesity | 41% to 46% |
| 2 | Coronary Artery Disease | 20% to 76% |
| 3 | Diabetes | 13% to 70% |
| 4 | Atrial Fibrillation | 15% to 41% |
| 5 | Hyperlipidemia | 16% to 77% |
Careful decisions are to be made, and it is required to eliminate the diseases that mimic the same symptoms of HFPEF. It is noted that unexplained hypertension in the elderly may cause HFPEF. It is suggested that such elderly be screened for the same regularly.
PHYSICAL EXAMINATION
On physical examination, a person with HFPEF shows signs of a third heart sound, lung crepitations, hepatomegaly, pedal edema, and elevated jugular venous pressure. Apart from physical examination, certain diagnostic tests are also run.
DIAGNOSTIC TESTS
As part of heart failure treatment, the diagnostic tests include a mix of lab tests, invasive and noninvasive image studies.
The lab tests include assessing the cardiovascular-related risks, renal function measures, helping eliminate the differential diagnosis, and screening for comorbidities. Doppler echocardiography is the necessary imaging used for the diagnosis. However, the golden standard for invasive imaging is using Cardiac Catheterization.
The crucial part of Heart Failure treatment of HFPEF, just like any other disease, is timely diagnosis and managing the symptoms. Post the treatment, adequate diet and exercise must be prescribed for recovery. The comorbidities must be kept in mind while chalking out the treatment plant for this type of heart failure. The comorbidities must be kept in mind while chalking out the treatment plant for this type of heart failure.
