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Patient education: Heart failure with preserved ejection fraction (The Basics)

Patient education: Heart failure with preserved ejection fraction (The Basics)

What is heart failure with preserved ejection fraction? — This is a type of heart failure. Heart failure is a condition in which the heart does not pump or fill with blood well. This causes the heart to lag behind in its job of moving blood throughout the body. This can lead to symptoms such as swelling, trouble breathing, and feeling tired.

There are 2 main types of heart failure:

In heart failure with preserved ejection fraction, the heart is too stiff. When the heart pumps, it doesn't relax and fill with blood normally. This type of heart failure is also known as "diastolic heart failure."

In heart failure with reduced ejection fraction, the heart is too weak. When the heart pumps, it doesn't squeeze normally. This type of heart failure is also known as "systolic heart failure."

The "ejection fraction" (or "EF") is the amount of blood that the heart pumps out with each heartbeat. People with "heart failure with preserved ejection fraction" have a normal (or almost normal) EF.

People with the other type of heart failure, "heart failure with reduced ejection fraction," have an EF that is lower than normal.

What are the symptoms of heart failure with preserved ejection fraction? — Symptoms can include:

Trouble breathing – At first, people might have trouble breathing only with activity. Over time, they can also have trouble breathing at rest or when lying down.

Swelling in the feet, ankles, legs, or belly

Feeling tired

Is there a test for heart failure? — Yes. If your doctor or nurse thinks you might have any type of heart failure, they will ask about your symptoms, do an exam, and order some of the following tests:

Blood tests

Chest X-ray – This test can show if there is fluid in the lungs. It also shows the general shape of the heart and large blood vessels in the chest.

Electrocardiogram (also called "ECG") – This test measures the electrical activity in the heart.

Echocardiogram (also called an "echo") – This test uses sound waves to create a picture of the heart as it beats.

Stress test – During this test, a doctor records your ECG while you exercise on a treadmill or bike, or get medicine to make your heart pump faster.

Cardiac catheterization (also called "cardiac cath") – During this test, the doctor puts a thin tube into a blood vessel in your leg or arm. Then they move the tube up to your heart. When the tube is in your heart or blood vessels, they will take blood pressure measurements. The doctor might also put a dye that shows up on an X-ray into the tube. This can show if any arteries in your heart are narrowed or blocked. This part of the test is called "coronary angiography."

How is heart failure with preserved ejection fraction treated? — Treatment usually includes:

Taking medicines – Doctors can use different types of medicines to treat your heart failure. The right medicines for you will depend on your symptoms and other medical conditions. Some medicines will reduce your symptoms, such as swelling or trouble breathing. This will help you feel better and be more able to do everyday tasks.

If you have fluid in your lungs or swelling in your legs, your doctor might prescribe a medicine called a "diuretic" (water pill) to help with these symptoms.

Your doctor might also prescribe a medicine called a "mineralocorticoid receptor antagonist." This helps the body get rid of extra salt and fluid. But it also helps the body hold onto a mineral called potassium. That's important, because the body needs potassium to work normally. A mineralocorticoid receptor antagonist might also protect the heart from harmful hormone effects that happen in heart failure.

You doctor might also prescribe an "SGLT2 inhibitor." This type of medicine is commonly used to treat diabetes. But it also helps to treat heart failure even if you do not have diabetes.

If you have high blood pressure, your doctor might prescribe medicines to control it. If you have a heart rhythm problem called "atrial fibrillation," your doctor might prescribe medicine to control your heart rate.

It's important to take your medicines every day, even if you feel well. Tell your doctor or nurse if you can't afford your medicines or if they cause side effects. There are often ways to help with these issues.

Treating your coronary heart disease (if you have it) – In coronary heart disease, the arteries that bring blood to the heart get clogged. Treatment can include medicines, a procedure to unblock a clogged artery, or surgery.

What else can I do on my own to protect my heart? — To help feel better and reduce the chances that you will need to go to the hospital, you can do the following:

Call your doctor or nurse if you are dizzy or weak, or if you lose or gain weight suddenly. Weigh yourself every morning after you urinate but before you eat breakfast. Try to wear about the same amount of clothing every time.

Follow the action plan your doctor gives you. An action plan is a list of instructions that tells you what to do if your symptoms change. To use an action plan, watch your symptoms closely and weigh yourself every day. If you do not feel well or if you lose or gain weight suddenly, look at your action plan to see what to do (figure 1 and figure 2).

Call for an ambulance (in the US and Canada, call 9-1-1) if you have chest pain or other signs of a heart attack (figure 3)

Lose weight, if you are overweight

Stop smoking

Limit the amount of alcohol you drink. For females, this means no more than 1 drink a day. For males, it means no more than 2 drinks a day.

More on this topic

Patient education: Heart failure (The Basics)
Patient education: Swelling (The Basics)
Patient education: Shortness of breath (dyspnea) (The Basics)
Patient education: Echocardiogram (The Basics)
Patient education: ECG and stress test (The Basics)
Patient education: Cardiac catheterization (The Basics)
Patient education: Coping with high drug prices (The Basics)
Patient education: Coronary artery disease (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Heart failure with reduced ejection fraction (The Basics)

Patient education: Edema (swelling) (Beyond the Basics)
Patient education: Shortness of breath (dyspnea) (Beyond the Basics)
Patient education: Heart failure (Beyond the Basics)
Patient education: Heart attack (Beyond the Basics)

This topic retrieved from UpToDate on: Jan 02, 2023.
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