Heart failure with preserved ejection fraction is now the most common form of heart failure. It is a complex disorder where patients have a stiff LV and a stiff arterial and venous system. Typically, these patients are older, are female, and have multiple comorbidities, including obesity, hypertension, renal disease, diabetes mellitus, and obstructive airway disease.
The clinical presentation is usually with symptoms of breathlessness and fatigue; physical signs of heart failure are less common. Patients often have labile hypertension, flash pulmonary edema, or deterioration in renal function with minor decreases in fluid volume. There are no specific medications for HFpEF itself, but management is directed to the comorbid conditions. Here the maxim is “go low and go slow,” because adverse effects are common.
The musculoskeletal system plays a large role in HFpEF. Many of the symptoms are due to abnormalities of peripheral vascular function and skeletal muscle dysfunction. Because of vasodilation failure with activity, patients may become very symptomatic with modest exertion. Short-term, low- to moderate-intensity aerobic exercise training promotes clinically significant increases in functional capacity and QOL scores—improvements that are attributed to skeletal muscle and not the pump itself. Long-term fitness is associated with a lower prevalence of diastolic dysfunction, less adverse LV remodeling, and lower LV filling pressures.