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 Pharmacology: • 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
