Early Recognition of Heart Failure with Preserved Ejection Fraction in Primary Care: A Case Report and Review of the Literature

Heart failure with preserved ejection fraction (HFpEF) a major cause of morbidity may be under-diagnosed in primary care, particularly among elderly patients with non-specific complaints. This case describes a 70-year-old hypertensive and obese female patient referred for progressive exertional dyspnea during the previous six months. On presentation, her BNP level was 210 pg/mL, and transthoracic echocardiography demonstrated preserved left ventricular ejection fraction of 60% with diastolic dysfunction consistent with HFpEF. The use of an aggressive multidisciplinary approach to management including diet and lifestyle modification as well as pharmacologic therapy, altogether yielding significant symptomatic improvement and sustained reduction in cardiac biomarkers was noted at 1 year. Ultimately, the patient became asymptomatic with BNP improved significantly and echocardiographic status stabilized. This case demonstrates the need for a low threshold for suspicion of HFpEF in high risk patients and the role of early identification and structured follow up in primary care.