Heart Failure with Preserved Ejection Fraction: Symptoms, Causes & Treatment

Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure in which the left ventricle keeps a near-normal pumping fraction (ejection fraction of 50% or more), but the problem is that the heart muscle becomes stiff and less elastic, so the heart does not fill adequately with blood between beats. As a result, pressure inside the heart rises and backs up into the lungs, producing symptoms.

This type differs from heart failure with reduced ejection fraction (HFrEF), in which the pumping strength itself is weak. HFpEF is more common in older adults, women, and people with hypertension, diabetes, obesity, and atrial fibrillation. Diagnosis is often challenging because the echocardiogram may look near-normal in terms of pumping.

Although traditional heart-failure medicines are less effective in this type, a newer class of drugs (SGLT2 inhibitors) has shown clear benefit. The cornerstone of treatment remains strict control of accompanying conditions and lifestyle modification, which improves symptoms and reduces hospital admissions.

• Shortness of breath on exertion, then at rest.
• Swelling of the legs and ankles.
• Fatigue and reduced exercise capacity.
• Breathlessness when lying down or at night.

• Chronic uncontrolled high blood pressure.
• Diabetes and obesity.
• Aging and stiffening of the heart muscle.
• Atrial fibrillation and kidney disease.

• Age over 60.
• Female sex.
• Hypertension, diabetes, and obesity.
• Physical inactivity.

• Echocardiography showing a preserved ejection fraction with signs of stiffness and filling problems.
• BNP or NT-proBNP blood test.
• Electrocardiogram and sometimes a stress test or catheterization.

Medications

• SGLT2 inhibitors, which have shown benefit in this type.
• Diuretics to relieve congestion and swelling.
• Blood-pressure control and treatment of atrial fibrillation.

Lifestyle

• Reducing salt and fluids as advised, weight loss, and regular physical activity.

This content is educational and does not replace consulting a cardiologist.

• Acute pulmonary congestion episodes needing hospital admission.
• Atrial fibrillation.
• Worsening kidney function.

• Control blood pressure and diabetes early.
• Maintain a healthy weight and stay active.
• Avoid smoking and reduce salt.