Differential Diagnosis for an Ejection Fraction of 30-35%

Single Most Likely Diagnosis

• Heart Failure with Reduced Ejection Fraction (HFrEF): This condition, formerly known as systolic heart failure, is characterized by the heart's inability to contract effectively, leading to a reduced ejection fraction. An ejection fraction of 30-35% is significantly below the normal range (typically >55%), making HFrEF the most likely diagnosis.

Other Likely Diagnoses

• Dilated Cardiomyopathy: A condition where the heart becomes enlarged and cannot pump blood effectively, often resulting in a reduced ejection fraction.
• Ischemic Cardiomyopathy: This occurs when the heart muscle is damaged due to coronary artery disease, leading to a decrease in the heart's ability to pump blood, thus reducing the ejection fraction.
• Non-ischemic Cardiomyopathy: Includes various forms of cardiomyopathy not caused by coronary artery disease, such as alcoholic cardiomyopathy or cardiomyopathy due to other toxic exposures, which can also lead to a reduced ejection fraction.

Do Not Miss Diagnoses

• Acute Myocardial Infarction (MI) with Cardiogenic Shock: Although the ejection fraction might be temporarily reduced in the setting of an acute MI, it's crucial to identify and treat promptly to prevent further cardiac damage.
• Cardiac Tamponade: A life-threatening condition where fluid accumulates in the sac around the heart, impeding its ability to pump. While the ejection fraction might not directly diagnose tamponade, its presence can lead to a reduced ejection fraction due to impaired cardiac filling.
• Severe Aortic or Mitral Regurgitation: Significant valvular disease can lead to a reduced ejection fraction due to the heart's inability to efficiently pump blood forward.

Rare Diagnoses

• Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare heart condition where the muscle in the right ventricle is replaced by fat and scar tissue, potentially leading to reduced heart function, including a decreased ejection fraction.
• Hypertrophic Cardiomyopathy with Reduced Ejection Fraction: Typically characterized by thickened heart muscle, in late stages, it can progress to a phase with reduced ejection fraction, although this is less common.
• Restrictive Cardiomyopathy: A condition where the heart muscle becomes stiff, making it difficult for the heart to fill with blood properly, which can lead to a reduced ejection fraction in advanced cases.

Each of these diagnoses has distinct implications for treatment and management, emphasizing the importance of a thorough diagnostic workup to determine the underlying cause of a reduced ejection fraction.