#HFpEF pearl of the day: If a patient with HF symptoms and normal LVEF has E/A ratio < 1 and PA systolic pressure > 50 mmHg on echo, it’s more likely PAH, not HFpEF. Low E/A ratio is due to underfilled LV due to pulmonary vascular obstruction in setting of PAH.
Here is my guide to differentiating PAH vs. CpcPH vs. HFpEF (pulmonary venous hypertension), published here: sciencedirect.com/science/articl…
And here is my checklist for the echo evaluation of PH, useful for evaluation of patients with #HFpEF:
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#HFpEF pearl of the day: HFpEF patients can have cardiac and extracardiac causes of volume overload. Abnormal LV GLS, reduced TDI velocities, and/or ⬆️⬆️ECG QRST angle (R axis – T axis) are clues to a more cardiac predominant phenotype.
Here’s another case: 49 yo woman w/obesity (BMI 46), HTN, OSA on CPAP, schizoaffective with new-onset HFpEF (leg swelling, dyspnea, ⬆️JVP, BNP 226 pg/ml, LVEF 65%). Low H2FPEF score = 4 (obesity, HTN meds, E/e’ = 10). What's the diagnosis? More info....
Hospitalized 6 months ago with psychotic break, treated with uptitration of anti-psychotics, now back to baseline mental status. 60-lb weight gain over past 6 mo. Also +lightheaded/dizzy. Here's the echo:
More info: normal thyroid function, normal hemoglobin, no eosinophilia. She was taking lamotragine, risperidone, and citalopram for her schizoaffective disorder. RHC: RA 13, PA 37/24, PCWP 24, CO 9.2 L/min.