Understanding Heart Failure with Preserved Ejection Fraction (HFpEF)
One increasingly common form of heart failure is called heart failure with preserved ejection fraction or HFpEF. Also known as diastolic heart failure, this condition affects how the heart fills with blood rather than how it pumps. Here’s what patients should know about how it works, how it’s diagnosed, and what treatment typically includes.
What is heart failure with preserved ejection fraction?
Heart failure with preserved ejection fraction means that the heart’s main pumping chamber, the left ventricle, still squeezes normally but has trouble relaxing and filling properly between beats.
“Preserved ejection fraction” refers to the percentage of blood pumped out of the heart with each beat. In HFpEF, this percentage remains in the normal range (usually 50 percent or higher), but the total amount of blood entering the heart may be reduced due to a stiff or thickened heart muscle.
This reduced filling capacity limits the amount of blood available to circulate throughout the body, which can lead to common heart failure symptoms, including fatigue and shortness of breath. This condition is often linked to long-term high blood pressure, aging, obesity, and other chronic conditions that make the heart muscle stiff or thickened over time.
How does HFpEF differ from other types of heart failure?
Heart failure can occur for different reasons, depending on how the heart’s function is impaired. In some cases, the heart muscle becomes weak and cannot pump blood effectively. This is called heart failure with reduced ejection fraction (HFrEF) or systolic heart failure.
In contrast, heart failure with preserved ejection fraction (HFpEF) happens when the heart still pumps well but becomes too stiff to relax and fill properly between beats. It’s like trying to inflate a balloon that is too rigid. Even if you apply enough pressure, it cannot expand as it should.
The key difference between these types is that HFrEF affects the contraction, while HFpEF affects the relaxation. Both can cause similar symptoms, like shortness of breath, swelling, and fatigue, but the underlying causes and treatment plans are different.
Many people associate heart failure with fluid buildup, often called congestive heart failure. While congestion can occur in either HFrEF or HFpEF, it is not what defines the condition. In HFpEF, the heart’s ability to fill is reduced, and fluid overload may or may not be present.
Symptoms of HFpEF
HFpEF can cause symptoms such as shortness of breath (especially with activity or when lying down), fatigue, swelling in the legs or ankles, sudden weight gain from fluid retention, frequent nighttime urination, and difficulty concentrating.
These symptoms may come and go and can vary depending on activity level, fluid balance, or other health conditions.
How is HFpEF diagnosed?
Diagnosing HFpEF usually involves a combination of tools, including:
- Echocardiogram – This ultrasound of the heart shows how well the heart pumps and fills.
- Ejection fraction measurement – A normal value (50 percent or higher) may point to HFpEF, especially when symptoms are present.
- Blood tests and EKG – These can rule out other causes or contributing conditions.
- Medical history – High blood pressure, diabetes, atrial fibrillation, obesity, or kidney disease can all increase the risk for HFpEF.
Because symptoms overlap with other heart or lung conditions, a thorough evaluation is important.
How is HFpEF treated?
Unlike HFrEF, for which several medications can improve outcomes, there is no single medication proven to reverse HFpEF. Treatment focuses on:
- Controlling risk factors by managing high blood pressure, diabetes, weight, and cholesterol.
- Treating contributing conditions like atrial fibrillation or sleep apnea that may worsen symptoms.
- Adopting lifestyle changes, including a heart-healthy diet, regular physical activity, stress reduction, and daily fluid and weight tracking.
While the condition cannot always be reversed, many patients live well with HFpEF when their care plan is tailored to their individual needs.
Personalized care for every patient
If you have been diagnosed with HFpEF or are experiencing symptoms like fatigue or shortness of breath, it is important to work closely with your care team. At Oklahoma Heart Hospital, we specialize in diagnosing and managing complex heart conditions, including diastolic heart failure.
Our team will help you understand your condition, monitor for changes, and adjust your care plan as needed to support long-term heart health. If you are concerned about symptoms or are looking for answers, we are here to help.