Cardiology
Heart Failure (HFpEF)
박출률보존심부전
HF with LVEF ≥50% due to diastolic dysfunction
- How common
- ~50% of HF patients
- Typical age
- Predominantly women 70+
What is it?
LV hypertrophy/fibrosis impairs relaxation → elevated LA/PV pressure → pulmonary congestion, dyspnea.
Commonly affected: LV (hypertrophy, normal EF), LA dilation
How it develops
- Chronic pressure overloadHTN is main cause
- Hypertrophy/fibrosisWalls thicken and stiffen
- Impaired relaxationLV does not fill properly
- Elevated LA/PV pressurePulmonary congestion, dyspnea
Symptoms
- Exertional dyspneaSimilar to HFrEF
- Orthopnea/PNDFrom pulmonary congestion
- Leg edemaBilateral pitting edema
- Reduced exercise toleranceCannot augment cardiac output
How it is examined
- Cardiac auscultationS4 gallop (specific for diastolic dysfunction)
- JVPElevated JVP
- BNP/NT-proBNPAdjunct for HF diagnosis
Imaging
CXR shows pulmonary edema.
- Pulmonary edema
- Mild cardiomegaly
Echo: EF ≥50%, elevated E/e' ratio, LA dilation.
- Preserved EF
- Diastolic dysfunction
- LA enlargement
Non-surgical care
- Aggressive BP controlTarget <130/80
- SGLT2 inhibitorEmpagliflozin/dapagliflozin (proven mortality/admission benefit)
- DiureticsFurosemide, torsemide
- Comorbidity managementAFib, obesity, DM, sleep apnea
- Cardiac rehabImproves exercise capacity
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Specific complications
Procedures that may be discussed
- AFib ablation (if related)
- Bariatric surgery (weight loss)
Outlook
5-yr mortality similar to HFrEF; SGLT2i reduce admissions.