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Heart failure with preserved ejection fraction (HFpEF) (diastolic heart failure) is a clinical syndrome that now accounts for at least half the cases of heart failure in adult patients. Decompensated HFpEF is a common and costly reason for admission to the hospital. From a pathophysiologic perspective, the left ventricle (LV) is stiff or noncompliant and characterized by an altered pressure-volume relationship. Asymptomatic LV diastolic dysfunction is a precursor to this clinical heart failure syndrome, and obesity and hypertension are the major risk factors for both diastolic dysfunction and HFpEF. Patients with early-stage HFpEF are characterized by euvolemic dyspnea. As the syndrome advances, congestion and atrial fibrillation develop. In late stages, pulmonary hypertension and the cardiorenal syndrome are common. The clinical course often results in recurrent hospital admissions for decompensated heart failure. Guideline-directed medical and device therapy, often beneficial for patients with heart failure with reduced ejection fraction (systolic heart failure), does not exist for patients with HFpEF. Decongestion is usually the only therapeutic option for patients with decompensated HFpEF, but diuresis can prove difficult in patients with the cardiorenal syndrome. Caring for such patients is frustrating and difficult.

Childhood Lifestyle Choices, Left Ventricular Diastolic Dysfunction, and the Terrific 2