Heart failure with normal and reduced ejection fraction - assessment and shared care management
- Author:
Rohit Khurana
- Publication Type:Journal Article
- Keywords:
Heart Failure;
shared care management;
reduced ejection fraction;
preserved ejection fraction;
BNP;
therapy
- From:The Singapore Family Physician
2019;45(2):27-31
- CountrySingapore
- Language:English
-
Abstract:
Heart failure (HF) is a common clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. HF may be caused by disease of the myocardium, pericardium, endocardium, heart valves, vessels, or by metabolic disorders. HF due to left ventricular dysfunction is categorized into HF with reduced ejection fraction (with Left Ventricular Ejection Fraction (LVEF) ≤50 percent, known as HFrEF; also referred to as systolic HF) and HF with preserved ejection fraction (with LVEF >50 percent; known as HFpEF; also referred to as diastolic HF.1 A reduced LVEF in systolic heart failure is a powerful predictor of mortality. As many as 40 -50 percent of patients with heart failure have diastolic heart failure with preserved left ventricular function. Overall, there is no difference in survival between diastolic and systolic heart failure that cannot be attributed to ejection fraction. Patients with diastolic heart failure are more likely to be women, to be older, and to have hypertension, atrial fibrillation, and left ventricular hypertrophy, but no history of coronary artery disease.2,3 The pathogenesis of diastolic dysfunction involves abnormalities of active ventricular relaxation and passive ventricular compliance, which lead to ventricular stiffness and higher diastolic pressures. These pressures are transmitted through atrial and pulmonary venous systems, reducing lung compliance. A combination of decreased lung compliance and cardiac output leads to symptoms.
