Summary of specific heart failure with preserved ejection fraction differential diagnosis and relative treatment
| Condition . | Clinical and instrumental findings . | Therapy . |
|---|---|---|
| Hypertrophic cardiomyopathy (HCM) | Asymmetric or global increase in LV wall thickness | General: avoid dehydration, rhythm control if AF |
| Possible LVOT obstruction | Obstructive HCM: BB, CCB, disopyramide, mavacamten, SRT49 | |
| Non-obstructive HCM: valsartan may slow LV remodelling when administered early50 | ||
| Cardiac amyloidosis | Global increase in LV wall thickness | TTR: tafamidis and other novel treatments51 |
| Restrictive pathophysiology | AL: haematological treatment | |
| Pulmonary hypertension (PH) not due to left-sided HF (Groups 1, 3, 4, and 5) | Type 1: idiopathic/hereditary PH | Aetiology-based treatment |
| Type 3: pulmonary disease–related PH | Specialist referral | |
| Type 4: CTPH | ||
| Type 5: rare disease | ||
| High-output HF | Elevated cardiac output may be due to obesity, arteriovenous shunts, liver disease, lung disease, and myeloproliferative disease | Aetiology-based treatment |
| Fabry disease | X-linked genetic transmission | ERT |
| Systemic symptoms/renal involvement | ||
| Restrictive pathophysiology | ||
| Cardiac sarcoidosis | Usually related to extracardiac sarcoidosis | Immunosoppression |
| Possible symptoms include ventricular arrythmias and heart failure | Specialist referral | |
| Constrictive pericarditis | Related to chest surgery or trauma, history of pericarditis, or connective tissue disease | Anti-inflammatory treatment if active pericarditis |
| Pericardiectomy |
| Condition . | Clinical and instrumental findings . | Therapy . |
|---|---|---|
| Hypertrophic cardiomyopathy (HCM) | Asymmetric or global increase in LV wall thickness | General: avoid dehydration, rhythm control if AF |
| Possible LVOT obstruction | Obstructive HCM: BB, CCB, disopyramide, mavacamten, SRT49 | |
| Non-obstructive HCM: valsartan may slow LV remodelling when administered early50 | ||
| Cardiac amyloidosis | Global increase in LV wall thickness | TTR: tafamidis and other novel treatments51 |
| Restrictive pathophysiology | AL: haematological treatment | |
| Pulmonary hypertension (PH) not due to left-sided HF (Groups 1, 3, 4, and 5) | Type 1: idiopathic/hereditary PH | Aetiology-based treatment |
| Type 3: pulmonary disease–related PH | Specialist referral | |
| Type 4: CTPH | ||
| Type 5: rare disease | ||
| High-output HF | Elevated cardiac output may be due to obesity, arteriovenous shunts, liver disease, lung disease, and myeloproliferative disease | Aetiology-based treatment |
| Fabry disease | X-linked genetic transmission | ERT |
| Systemic symptoms/renal involvement | ||
| Restrictive pathophysiology | ||
| Cardiac sarcoidosis | Usually related to extracardiac sarcoidosis | Immunosoppression |
| Possible symptoms include ventricular arrythmias and heart failure | Specialist referral | |
| Constrictive pericarditis | Related to chest surgery or trauma, history of pericarditis, or connective tissue disease | Anti-inflammatory treatment if active pericarditis |
| Pericardiectomy |
AF, atrial fibrillation; AL, amyloid light chain; BB, beta blockers; CCB, calcium channel blockers; CTPH, chronic thromboembolic pulmonary hypertension; ERT, enzyme replacement therapy; LV, left ventricular; LVOT, left ventricular outflow tract; SRT, septal reduction therapy; TTR, transthyretin.
Summary of specific heart failure with preserved ejection fraction differential diagnosis and relative treatment
| Condition . | Clinical and instrumental findings . | Therapy . |
|---|---|---|
| Hypertrophic cardiomyopathy (HCM) | Asymmetric or global increase in LV wall thickness | General: avoid dehydration, rhythm control if AF |
| Possible LVOT obstruction | Obstructive HCM: BB, CCB, disopyramide, mavacamten, SRT49 | |
| Non-obstructive HCM: valsartan may slow LV remodelling when administered early50 | ||
| Cardiac amyloidosis | Global increase in LV wall thickness | TTR: tafamidis and other novel treatments51 |
| Restrictive pathophysiology | AL: haematological treatment | |
| Pulmonary hypertension (PH) not due to left-sided HF (Groups 1, 3, 4, and 5) | Type 1: idiopathic/hereditary PH | Aetiology-based treatment |
| Type 3: pulmonary disease–related PH | Specialist referral | |
| Type 4: CTPH | ||
| Type 5: rare disease | ||
| High-output HF | Elevated cardiac output may be due to obesity, arteriovenous shunts, liver disease, lung disease, and myeloproliferative disease | Aetiology-based treatment |
| Fabry disease | X-linked genetic transmission | ERT |
| Systemic symptoms/renal involvement | ||
| Restrictive pathophysiology | ||
| Cardiac sarcoidosis | Usually related to extracardiac sarcoidosis | Immunosoppression |
| Possible symptoms include ventricular arrythmias and heart failure | Specialist referral | |
| Constrictive pericarditis | Related to chest surgery or trauma, history of pericarditis, or connective tissue disease | Anti-inflammatory treatment if active pericarditis |
| Pericardiectomy |
| Condition . | Clinical and instrumental findings . | Therapy . |
|---|---|---|
| Hypertrophic cardiomyopathy (HCM) | Asymmetric or global increase in LV wall thickness | General: avoid dehydration, rhythm control if AF |
| Possible LVOT obstruction | Obstructive HCM: BB, CCB, disopyramide, mavacamten, SRT49 | |
| Non-obstructive HCM: valsartan may slow LV remodelling when administered early50 | ||
| Cardiac amyloidosis | Global increase in LV wall thickness | TTR: tafamidis and other novel treatments51 |
| Restrictive pathophysiology | AL: haematological treatment | |
| Pulmonary hypertension (PH) not due to left-sided HF (Groups 1, 3, 4, and 5) | Type 1: idiopathic/hereditary PH | Aetiology-based treatment |
| Type 3: pulmonary disease–related PH | Specialist referral | |
| Type 4: CTPH | ||
| Type 5: rare disease | ||
| High-output HF | Elevated cardiac output may be due to obesity, arteriovenous shunts, liver disease, lung disease, and myeloproliferative disease | Aetiology-based treatment |
| Fabry disease | X-linked genetic transmission | ERT |
| Systemic symptoms/renal involvement | ||
| Restrictive pathophysiology | ||
| Cardiac sarcoidosis | Usually related to extracardiac sarcoidosis | Immunosoppression |
| Possible symptoms include ventricular arrythmias and heart failure | Specialist referral | |
| Constrictive pericarditis | Related to chest surgery or trauma, history of pericarditis, or connective tissue disease | Anti-inflammatory treatment if active pericarditis |
| Pericardiectomy |
AF, atrial fibrillation; AL, amyloid light chain; BB, beta blockers; CCB, calcium channel blockers; CTPH, chronic thromboembolic pulmonary hypertension; ERT, enzyme replacement therapy; LV, left ventricular; LVOT, left ventricular outflow tract; SRT, septal reduction therapy; TTR, transthyretin.
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