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Heart failure with preserved ejection fraction (HFpEF) occurs when the lower left chamber (left ventricle) is not able to fill properly with blood during the diastolic (filling) phase. The amount of blood pumped out to the body is less than normal.
It is also called diastolic heart failure.
The types of heart failure are based on a measurement called the ejection fraction. The ejection fraction measures how much blood inside the ventricle is pumped out with each contraction. The left ventricle squeezes and pumps some (but not all) of the blood in the ventricle out to your body. A normal ejection fraction is more than 55%. This means that 55% of the total blood in the left ventricle is pumped out with each heartbeat.
Heart failure with preserved ejection fraction (HFpEF) happens when the left ventricle is not filling with blood as well as normal. The ventricle can pump well. But it may be stiff so it cannot relax and fill with blood as well as normal. The ejection fraction is 50% or more. HFpEF may also be diagnosed if the ejection fraction is 40% to 49%.footnote 1
Although the ejection fraction may be normal, the heart has less blood inside it to pump out. So the heart pumps out less blood than the body needs.
Examples of ejection fractions of a healthy heart and a heart with preserved ejection fraction:
HFpEF happens because the left ventricle's muscle becomes too stiff or thickened. To compensate for stiff heart muscle, your heart has to increase the pressure inside the ventricle to properly fill the ventricle. Over time, this increased filling causes blood to build up inside the left atrium and eventually into the lungs, which leads to fluid congestion and the symptoms of heart failure.
The most common cause of diastolic heart failure is the natural effect of aging on the heart. As you age, your heart muscle tends to stiffen, which can prevent your heart from filling with blood properly, leading to diastolic heart failure.
But there are many health problems that can impair your left ventricle's ability to fill properly with blood during diastole.
What is it?
How it causes heart failure
Coronary artery disease (CAD)
Blockage of the arteries that supply blood to the heart
Low blood flow to the heart muscle (ischemia) can prevent the heart from relaxing and filling with blood.
High blood pressure
Elevated pressure in your arteries
Heart muscle can thicken the wall of the heart (hypertrophy) in an effort to pump against high blood pressure. Thickened heart muscle limits the heart's ability to relax and fill with blood.
Narrowed opening of the aortic valve
The left ventricle thickens, limiting its ability to fill.
Inherited abnormality of heart muscle resulting in very thick walls of the left ventricle
Thick heart muscle prevents blood from filling the left ventricle.
Abnormality of the sac that surrounds the heart (pericardium)
Fluid in the pericardial space (pericardial tamponade) or a thickened pericardium (pericardial constriction) can limit the heart's ability to fill.
CitationsYancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16): e147-e239.Other Works ConsultedYancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16): e147-e239.Zile MR, Little WC (2015). Heart failure with a preserved ejection fraction. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 1, pp. 557-574. Philadelphia: Saunders.
ByHealthwise StaffPrimary Medical ReviewerRakesh K. Pai, MD - Cardiology, ElectrophysiologyE. Gregory Thompson, MD - Internal MedicineMartin J. Gabica, MD - Family MedicineAdam Husney, MD - Family MedicineSpecialist Medical ReviewerStephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Current as ofDecember 6, 2017
Current as of: December 6, 2017
Author: Healthwise Staff
Medical Review: Rakesh K. Pai, MD - Cardiology, Electrophysiology & E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Adam Husney, MD - Family Medicine & Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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