Heart failure with Reduced Ejection Fraction (HFrEF)
Clinical ...

Heart failure with Reduced Ejection Fraction (HFrEF)

Clinical Presentation

1. Typical symptoms: dyspnea, orthopnea paroxysmal noctumal dyspnea, fatigue, reduced exercise tolerance, and ankle swelling.

2. Less Typical Symptoms: cough, abdominal distension, wheeze, abdominal bloating, and early satiety, bendopnea.

3. More Specific Signs: elevated jugular venous pressure, positive abdominojugular, reflux s3 (gallop rhythm), and laterally displaced apical impulse.

4. Less Specific Signs: weight gain, lung rales, peripheral edema, ascites, cool and/or mottled extremities, narrow proportional pulse pressure (pulse pressure: systolic blood pressure ratio 0.25), murmur of valvular regurgitation or stenosis, weight loss and cachexia (advanced heart failure).

*Chronic HFrEF may lack lung rales, peripheral edema compensatory upregulation un lymphatic

Diagnostic Imaging:

1. Chest x-ray: signs of congestion (Sens. 81% for acute HF), cardiomegaly (S 64-79%), 95% specificity or >: (peribronchial cuffing, Kerley B lines, alveolar edema, bilateral pleural effusions). 1/5 pts w/ acute HF → no signs of CXR congestion.

2. Transthoracic echocardiography: identifies systolic dysfunction

3. Coronary angiography (or coronary computed tomography angiography if low pretest probability): identificaton of obstructive epicardial coronary artery disease

4. Consider cardiac magnetic resonance imaging, positron emission tomography scan, or 99m technetium pyrophosphate scan.

Other: Electrocardiogram, Consider right heart catheterization, consider endomyocardial biopsy


 • ACE Inhibitors and ARBs

 • ARNIs (Angiotensin receptor-neprilysin inhibitors) 

 • ß-Blockers

 • MRAs (Mineralocorticoid receptor antagonists)

 • Ivabradine

 • Hydralazine / Isosorbide Dinitrate

 • Diuretics

- Dr. Jorge Cortés @Jcortesizaguirr

#HFrEF #heartfailure #diagnosis #management #cardiology #pharmacology #sCHF
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