Skill Checkup: A 62-Year-Old Black Male With History of Hypertension Experiences Mild Cognitive Impairment and Breathlessness

Jeffrey J. Hsu, MD


March 13, 2023

An echocardiogram is the best initial option for evaluating a patient for HF because it provides a comprehensive assessment of the heart's structure and function using ultrasound. HF can be classified as heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF). HFrEF is characterized by a reduced ability of the heart to pump blood, indicated by an ejection fraction of < 40%. On the other hand, HFpEF is characterized by normal or near-normal ejection fraction but impaired diastolic function, meaning the heart has difficulty relaxing and filling with blood. The echocardiogram can determine the ejection fraction and detect diastolic dysfunction, providing crucial information for diagnosing both types of HF.

An exercise stress test assesses the heart's ability to respond to external stress and can be used to help diagnose coronary artery disease, but it is not as comprehensive as an echocardiogram in evaluating the overall structure and function of the heart. The coronary artery calcium score measures the amount of calcium buildup in the coronary arteries, which indicates the presence of coronary artery disease but does not provide information about the heart's function. The INR test is used to measure the time to clot formation in patients on warfarin therapy, but this patient is not currently taking warfarin.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.