Skill Checkup: A 65-Year-Old Woman With Treated Type 2 Diabetes Presents With Shortness of Breath and Lightheadedness

Romesh Khardori, MD, PhD


February 23, 2023

HF is broadly defined as a clinical syndrome with symptoms that are owing to impaired ventricular filling or ejection of blood. There are two distinct phenotypes of HF based on LVEF. HFrEF is defined as LVEF ≤ 40%, and HF with preserved EF (HFpEF) is defined as LVEF ≥ 50%. In between, LVEF 41%-49% is considered LVEF mildly reduced. Additionally, patients who present with HFrEF and receive effective treatment may show improvement, with LVEF increasing to > 40%.

AHA/ACC/HFSA guidelines define four stages of HF: stage A is at risk for HF based on existing risk factors. Stage B is pre-HF, based on evidence of structural damage to the heart without clinical symptoms, and is a key point of intervention to prevent HF development. Stage C is symptomatic HF and includes patients with clinical symptoms of varying severity. Stage D is advanced HF.

NYHA classification is based on a patient's functional ability and ranges from I (no limitations) to IV (unable to carry out functions and symptomatic at rest). This patient experiences symptoms of mild dyspnea and fatigue with ordinary activity, but these rarely limit her ability to complete daily tasks, which characterizes NYHA class II. Class III is comfortable at rest, but symptomatic with marked limitations in performing ordinary activities.


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