Skill Checkup: A Woman With Long‐standing Hypertension and Worsening Dyspnea on Exertion

Yasmine S. Ali, MD


December 23, 2021

Diagnosis of heart failure with preserved ejection fraction (HFpEF) can be difficult because many conditions may mimic it on presentation. Cardiac conditions in the differential diagnosis of HFpEF include heart failure with reduced ejection fraction (HFrEF) with overestimation of the EF, valvular disease, atrial myxoma, pericardial disease, restrictive or hypertrophic cardiomyopathy, intracardiac shunt, severe hypertension, and acute coronary syndrome complicated by pulmonary edema. Chronic obstructive pulmonary disease and other chronic lung diseases are prevalent in patients with HFpEF, and pulmonary hypertension can be a component of both. Thus, the diagnosis of HFpEF is often made after ruling out other causes for the symptoms.

In a patient with dyspnea who has a normal LVEF, the gold standard for diagnosing HFpEF remains invasive hemodynamic assessment with right-heart catheterization.


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