Today, I review, link to and embed CORE IM‘s Behinds the Scenes Videos: Heart Failure with Preserved Ejection Fraction.
Posted: June 23, 2024
By: Dr. Alice Kennedy, Dr. Shreya P. Trivedi, Dr. Jennifer Ho, Dr. Rati Vani and Dr. Waleed Rehman
Audio: Dr. Alice Kennedy
All that follows is from the above resource.
Key Points:
– Definition: Clinical syndrome of volume overload and elevated left filling pressures at rest OR exercise in a patient EF of 50% or higher
– No single diagnostic test
– “Garden Variety” HFpEF is 2/2 to cardiometabolic risk factors
– Masqueraders of HFpEF:
1. Primary cardiomyopathy: restrictive or hypertrophic cardiomyopathy
2. High output HF in the setting of anemia, hyperthyroidism, and cirrhosis
3. Primary cardiac abnormalities: valvular, coronary, or pericardial disease
Description:
What do cardiologists mean by Heart Failure with Preserved Ejection Fraction? What really defines it and how can we distinguish this syndrome from common mimickers, or as our expert Dr Jen Ho describes them, “HFpEF Masqueraders”? This video provides high-yield clarification about this often confusing topic.
Jun 23, 2024 #internalmedicine #cardiology #residency
Key Points on Echo, BNP and Advanced Testing:
- No echo finding alone diagnoses HFpEF, but supportive results include:
- 1. LA dilation
- 2. LV diastolic dysfunction
- 3. LV hypertrophy
- Echo can be normal in some patients with HFpEF
- Other causes of pro-BNP elevation: CKD, atrial fibrillation, and female sex
- Advanced hemodynamic testing may reveal diastolic dysfunction with exercise in difficult cases
- Cardiac MRI may help to exclude “HFpEF masqueraders”
Video Description: What tools are best suited for evaluating and diagnosing Heart failure with preserved ejection fraction? Cardiologist, Dr. Jen Ho explains what information these techniques provide and how they can help us understand our patient’s physiology.
Jun 23, 2024 #internalmedicine #cardiology #residency
Key Points on Pathogenesis and Risk Factors:
- Pathogenesis is incompletely understood but related to obesity and metabolic disease
- Both the incidence and prevalence of HFpEF is increasing likely due to the obesity epidemic and the downstream consequences of it
- HFpEF has a strong association with obesity and metabolic dysfunction
- Risk factors for HFpEF include increasing age, hypertension, and heart disease
- Prevalence is greater among females
Key Points on Treatment:
- Manage risk factors !
- SGLT-2 inhibitors
- MRAs
- ARNIs
- Loop diuretics for congestion
- Avoid beta blockers unless there is another indication as they may decrease functional status
- Picking a diuretic dose is largely trial and error
Relevant Podcast with complete show notes & transcript:
- Guest discussant: Dr. Jen Ho
- Original Interview by Dr. Rati Vani and Dr. Shreya P. Trivedi
- Video by Dr. Waleed Rehman and Dr. Alice Kennedy
