Heart failure occurs when the heart cannot effectively pump or fill with enough blood to meet the body’s demands, struggling to circulate oxygen and nutrients. An echocardiogram, often called an “echo,” is an ultrasound that uses sound waves to create moving pictures of the heart’s structure and function, including its pumping strength.
It is possible to experience heart failure even when an echocardiogram appears normal. This condition is known as heart failure with preserved ejection fraction (HFpEF). While a normal echocardiogram suggests adequate pumping action, HFpEF reveals a different underlying problem that still leads to heart failure symptoms.
Understanding Heart Failure with Preserved Ejection Fraction
A normal echocardiogram typically indicates a healthy ejection fraction, which is the percentage of blood pumped out of the heart’s main pumping chamber, the left ventricle, with each beat. A normal ejection fraction is generally 50% or greater. In HFpEF, the heart’s pumping ability often remains within this normal range.
The core issue in HFpEF is not the heart’s ability to pump, but its inability to relax and fill properly with blood during the resting phase between beats. Imagine a bicycle pump that pushes air out forcefully but cannot fully retract to draw in enough air. Similarly, the heart muscle in HFpEF becomes stiff and less flexible, hindering its capacity to adequately fill with blood. This stiffness leads to increased pressures within the heart chambers, even with a normal pumping percentage.
This condition contrasts with heart failure with reduced ejection fraction (HFrEF), where the heart muscle is weakened and cannot contract forcefully enough to pump sufficient blood. In HFrEF, the ejection fraction is typically 40% or lower, indicating a problem with the heart’s squeezing action. HFpEF, however, involves a filling problem, even though the heart’s overall squeezing strength appears preserved.
Recognizing the Signs of Heart Failure with Preserved Ejection Fraction
Individuals with HFpEF often experience symptoms similar to other forms of heart failure. Shortness of breath is common, occurring with physical exertion or when lying flat. This breathlessness happens because the stiff heart cannot properly fill, causing fluid to back up into the lungs, increasing pressure.
Fatigue and reduced exercise capacity are also reported. The heart’s impaired filling means less blood and oxygen are delivered to tissues during activity, leading to tiredness and difficulty performing tasks. Swelling in the legs, ankles, or feet (edema) can also develop. This fluid buildup occurs as increased pressures in the heart cause fluid to leak from blood vessels into surrounding tissues.
Beyond the Echocardiogram: Diagnosing Heart Failure with Preserved Ejection Fraction
Diagnosing HFpEF can be challenging because the echocardiogram may show a normal ejection fraction. Diagnosis relies on a comprehensive evaluation that goes beyond just the echo results, considering a patient’s symptoms, medical history, and physical examination findings. Additional diagnostic tests help confirm HFpEF and rule out other conditions.
Blood tests, such as B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP), are used. These hormones are released when the heart muscle is stretched; elevated levels can indicate increased pressure within the heart. Exercise stress tests may also assess how symptoms manifest under physical exertion, unmasking filling problems not apparent at rest.
Advanced imaging techniques like cardiac MRI provide detailed images of the heart’s structure and function, helping identify subtle changes in muscle thickness or stiffness. In some cases, right heart catheterization might be necessary. This invasive procedure directly measures pressures within the heart chambers, offering evidence of elevated filling pressures characteristic of HFpEF. Diagnosis is ultimately a combination of these findings, rather than relying on a single test.
Managing Heart Failure with Preserved Ejection Fraction
Managing HFpEF focuses on alleviating symptoms, enhancing quality of life, and addressing underlying health conditions that contribute to the disorder. Lifestyle adjustments are a cornerstone of management, often including dietary modifications like limiting sodium intake to reduce fluid retention and ease the heart’s workload.
Regular physical activity, tailored to individual capabilities, improves exercise tolerance and overall well-being. Weight management is important, as obesity frequently contributes to HFpEF, and losing weight can improve heart function. Controlling co-existing conditions like high blood pressure, diabetes, and kidney disease is also central to the management strategy. Treating these conditions can reduce stress on the heart and potentially slow the progression of HFpEF.
While specific drug therapies for HFpEF are an active area of research, the approach often involves medications to manage symptoms like fluid buildup and control associated conditions. Diuretics, for instance, are commonly used to reduce fluid overload. The overall management plan is highly individualized, focusing on each patient’s specific needs and contributing factors.