Heart Failure With a Preserved Ejection Fraction

Introduction

The heart is a muscular organ that is the size of a fist and is placed at the center of the circulation system. The heart's main function is to pump blood around the body as the heart beats. Due to lifestyle changes, and eating habits, fatty acids deposit in the arteries, and this reduces blood flow and results in a heart attack. The condition where the heart fails to pump the blood as it should result in congestive heart failure, commonly known as heart failure. There are three types of heart failure: left-sided heart failure, right-sided heart failure, systolic heart failure, and diastolic heart failure.

What Is Heart Failure With a Preserved Ejection Fraction?

Heart failure with preserved ejection fraction is also known as diastolic heart failure, which can be almost one in half of five million cases of heart failure. The ejection fraction of over half of all heart failure patients is within normal limits (EF). Heart failure with preserved ejection fraction (HFpEF) is a syndrome that is more widespread in the industrialized world than it used to be. This is probably due to the rising frequency of common risk factors such as older age, female sex, hypertension, metabolic syndrome, renal dysfunction, and obesity. Hypertension is the strongest risk factor in around 80 to 90 % of individuals with heart failure with preserved ejection fraction. Ventricular systolic and diastolic reserve abnormalities, stiffening of ventricular tissue, atrial dysfunction, pulmonary hypertension, chronotropic incompetence, endothelial dysfunction, and impaired vasodilation are all implicated.

What Are the Risk Factors of Heart Failure With Preserved Ejection Failure?

The risk factors contribute to diverse mechanisms for developing heart failure with preserved ejection failure. The clear risk factors that contribute are obesity, metabolic syndrome, hypertension, and a sedentary lifestyle. There is clear epidemiological evidence of a mechanistic link between insulin resistance and heart failure with preserved ejection failure. The pro-inflammatory action induces changes in the vascular endothelium of the heart, reducing the availability of nitric oxide as an important vasodilator and regulator of protein kinase G activity. This activity diminishes cardiomyocytes undergoing hypertrophic changes.

• Hypertension - Increased ventricular afterload can lead to structural changes in the heart. Increased pressure with a pro-inflammatory state leads to ventricular stiffening that can result in poor cardiac output in heart failure with preserved ejection failure.

• Aging - Cellular deterioration or cardiac senescence occurs as a part of normal aging, loss of cardiac reserve, diminished vascular compliance, and diastolic dysfunction is their characteristics. Senile systemic amyloidosis results from the accumulation of aggregated wild-type transthyretin as a part of the degenerative aging process.

• Ischemia - Inadequate oxygenation of the myocardium is seen in a high proportion of heart failure with preserved ejection failure. Secondary to coronary artery disease as described by previous changes in the microvasculature. Ischemia may manifest in many ways due to increased tissue oxygen demand or diminished heart ability to supply oxygen.

• Other - Any condition that results in stiffening of the left ventricle has the capacity to lead to diastolic dysfunction. The causes of this stiffening are aortic stenosis, elderly people with hypertension, and diabetes.

What Are the Symptoms of Heart Failure With a Preserved Ejection Fraction?

The signs and symptoms of heart failure with preserved ejection are similar to those observed in HFrEF (HF with reduced ejection fraction); this includes shortness of breath like dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, exercise intolerance, edema, and elevated jugular venous pressure. Individuals with heart failure with preserved ejection fraction have poorly tolerated stress, hemodynamic alterations of ventricular loading, and increased diastolic pressure. There is an incredible elevation in systolic blood pressure in heart failure with preserved ejection failure.

How Is the Diagnosis of Heart Failure With a Preserved Ejection Fraction Done?

The most common complaints that are present are exertional dyspnea and fatigue. Three criteria are met to establish the diagnosis:

• Clinical symptoms with consistent heart failure.

• Preserved EF (nearly 50 %).

• Evidence of cardiac symptoms.

Potential findings demonstrating cardiac dysfunction include evidence of congestion on physical examination of chest X-ray, echocardiographic evidence of diastolic dysfunction, atrial fibrillation, pulmonary hypertension, engorged inferior vena cava, and elevated brain natriuretic peptide.

Invasive hemodynamic testing may be helpful if the diagnosis is still unclear following testing. Elevated filling pressures at rest support the diagnosis of HFpEF, but many people only exhibit hemodynamic compromise under stress. Exercise-related hemodynamic measures in these patients are crucial.

What Is the Life Expectancy of an Individual With Heart Failure With Preserved Ejection Fraction?

Heart failure itself is a life-threatening condition. Individuals hospitalized with heart failure survived a median of 2.1 years. Around 75 % of patients with heart failure with preserved ejection fraction passed away within five years. Heart failure and cardiovascular readmission rates are higher in those with heart failure with ejection fraction along with preserved ejection fraction. This depends on how much fluid retention is present, and severe heart function is affected by age, overall health, and the treatment received. The other health condition and cardiovascular risk factors are:

• Obesity.

• Diabetes.

• Coronary artery disease (a condition that affects the heart happens when the coronary artery struggles to supply enough blood to the heart).

• High blood pressure.

• Chronic kidney disease.

• Atrial fibrillation (an irregular and often very rapid heart rhythm that can lead to blood clots in the heart).

Getting treatment for chronic conditions along with heart failure with preserved ejection fraction can improve quality of life along with practicing healthy habits.

Conclusion

Almost half of the individuals worldwide have heart failure, and half have heart failure with preserved ejection fraction. The condition reduces the oxygen-rich blood the heart delivers to other organs and tissues and increases heart pressure. This can cause uncomfortable signs and symptoms and the risk of potentially life-threatening complications. It is much more important to get treatment for a failed heart with preserved ejection fraction and other underlying medical conditions with the help of prescribed medications and treatments. This step also involves changes in lifestyle that protect the heart and overall health.