What should I bring and ask during my appointment with a Heart Failure Specialist given my history of declining Ejection Fraction (EF) and diastolic dysfunction?

Preparing for Your Heart Failure Specialist Appointment

Bring a comprehensive list of all your cardiac imaging reports from the past four years showing your declining ejection fraction trend, your most recent echocardiogram with the stroke volume index of 23.69 ml/m², documentation of your diastolic dysfunction grade 1, and your LV hypertrophy measurements—these serial measurements are critical for the specialist to assess your disease progression and guide treatment decisions. 1

Essential Documents to Bring

Cardiac Testing Records

• All echocardiogram reports from the past 4 years showing your EF decline trajectory, including specific measurements of left ventricular size, wall thickness, and any changes in diastolic function parameters 1
• Your most recent ECG to document any conduction abnormalities, left ventricular hypertrophy patterns, or arrhythmias 1
• Any chest X-rays (if available) showing cardiac silhouette size and pulmonary vasculature 1

Laboratory Results

• Recent comprehensive metabolic panel including serum creatinine, blood urea nitrogen, and electrolytes (sodium, potassium, calcium, magnesium) 1
• Complete blood count to assess for anemia which can worsen heart failure 1
• Thyroid function tests (TSH) as thyroid disorders can contribute to cardiac dysfunction 1
• Fasting glucose or hemoglobin A1c and lipid profile 1
• BNP or NT-proBNP levels if previously measured, as these track disease severity 2

Medication and Exposure History

• Complete current medication list with doses and frequency 1
• Documentation of any chemotherapy exposure or cardiotoxic drugs you've received 1, 2
• History of alcohol consumption (quantity and duration), illicit drug use, and any alternative therapies or supplements 1, 2

Functional Status Documentation

• Written diary or notes describing your exercise tolerance, how many blocks you can walk, flights of stairs you can climb, and any activities of daily living that have become difficult 1, 2
• Weight log if you've been tracking daily weights 1, 2

Critical Questions to Ask Your Specialist

About Your Diagnosis and Prognosis

• "What is my current ejection fraction and how does it compare to my baseline?" This establishes where you are in the disease spectrum 1
• "Do I have heart failure with reduced ejection fraction (HFrEF), and what stage am I in?" Understanding your ACC/AHA stage (A, B, C, or D) guides treatment intensity 1
• "What is causing my declining EF—is it ischemic heart disease, hypertension, or another cause?" The etiology determines specific interventions 1, 3

About Coronary Artery Disease Evaluation

• "Do I need coronary angiography to rule out coronary artery disease as the cause?" This is particularly important because the ACC gives a Class IIa recommendation for coronary angiography in patients with known or suspected coronary disease even without angina, and a Class I recommendation if you have any chest discomfort 1, 3
• "Should I have stress testing or other imaging to look for ischemia?" Non-invasive testing may identify reversible ischemia 1, 3

About Medical Therapy

• "Should I be on an ACE inhibitor or ARB, beta-blocker, and mineralocorticoid receptor antagonist (MRA)?" These are the cornerstone therapies for HFrEF that reduce mortality and hospitalization 1
• "Am I a candidate for sacubitril/valsartan (Entresto) instead of an ACE inhibitor?" This combination reduces HF hospitalization and death more than ACE inhibitors alone in symptomatic patients 1
• "What are the target doses for my medications, and how quickly should we titrate?" Optimal dosing is critical for mortality benefit 1
• "Do I need diuretics for fluid management?" Even with diastolic dysfunction, diuretics improve symptoms if congestion is present 1

About Device Therapy

• "Am I a candidate for an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden death?" If your EF is ≤35% despite 3 months of optimal medical therapy and you have reasonable life expectancy, an ICD reduces mortality 1
• "Would I benefit from cardiac resynchronization therapy (CRT)?" This depends on your QRS duration and morphology on ECG 1

About Monitoring and Follow-up

• "How often should I have repeat echocardiograms to monitor my EF?" Serial imaging is recommended when there's been a change in clinical status or after treatment changes 1
• "What symptoms should prompt me to call immediately versus wait for my next appointment?" Understanding red flags prevents delayed intervention 1
• "Should I be monitoring daily weights, and what weight gain should trigger action?" Weight monitoring detects early fluid retention 1, 2

About Lifestyle and Comorbidities

• "What is my sodium restriction target?" Dietary sodium management is important for volume control 1
• "How much can I exercise, and should I participate in cardiac rehabilitation?" Exercise capacity assessment guides activity recommendations 1
• "Are there medications I should avoid?" NSAIDs, certain calcium channel blockers (diltiazem, verapamil), and other drugs can worsen heart failure 1

Tests to Request or Discuss

If Not Recently Done

• Repeat echocardiogram with comprehensive Doppler assessment to precisely quantify your current EF, stroke volume index, diastolic function parameters, and assess for mitral regurgitation 1
• BNP or NT-proBNP measurement to objectively assess heart failure severity and establish a baseline for monitoring 2
• Coronary evaluation (either stress imaging or angiography) if you have any risk factors for coronary disease or if the etiology of your cardiomyopathy is unclear 1, 3

Additional Testing Based on Clinical Context

• Cardiac MRI if there's uncertainty about the cause of your cardiomyopathy or to assess for infiltrative diseases or myocarditis 1
• Holter monitor or event recorder if you have palpitations or suspected arrhythmias 1
• Cardiopulmonary exercise testing to objectively quantify your functional capacity and guide prognosis 1

Common Pitfalls to Avoid

Do not minimize your symptoms—be honest about exercise intolerance, orthopnea, paroxysmal nocturnal dyspnea, or leg swelling, as these guide treatment intensity 1, 2

Do not assume your diastolic dysfunction is "mild" and therefore unimportant—diastolic dysfunction is present across all heart failure phenotypes and contributes to symptoms 4, 5, 6

Do not delay coronary evaluation if recommended—ischemic heart disease is a reversible cause of declining EF, and revascularization can improve outcomes 1, 3

Do not accept "watchful waiting" if your EF is declining—early initiation of guideline-directed medical therapy prevents further remodeling and improves survival 1

Ensure the specialist addresses whether you're on optimal doses of evidence-based medications—many patients are under-dosed on ACE inhibitors, beta-blockers, and MRAs, which limits their benefit 1