Differential Diagnosis for Heart Failure with Reduced Ejection Fraction
Single Most Likely Diagnosis
- Ischemic Cardiomyopathy: This is often the most common cause of heart failure with reduced ejection fraction (HFrEF), particularly in populations with high rates of coronary artery disease. It occurs when the heart muscle is damaged due to a heart attack or reduced blood flow to the heart, leading to a decrease in the heart's ability to pump blood efficiently.
Other Likely Diagnoses
- Hypertensive Heart Disease: Long-standing hypertension can lead to left ventricular hypertrophy and eventually heart failure with reduced ejection fraction. The chronic pressure overload causes the heart muscle to thicken, which can impair its pumping function.
- Dilated Cardiomyopathy: This condition is characterized by an enlargement of the heart's chambers, reducing its ability to contract and, therefore, pump blood effectively. It can be idiopathic or result from various factors, including alcohol abuse, infections, and genetic predispositions.
- Valvular Heart Disease: Conditions such as mitral regurgitation or aortic stenosis can lead to heart failure with reduced ejection fraction if left untreated or poorly managed. The abnormal valve function increases the workload on the heart, potentially leading to failure.
Do Not Miss Diagnoses
- Cardiac Amyloidosis: Although less common, cardiac amyloidosis can present with heart failure with reduced ejection fraction and is crucial to diagnose due to its distinct treatment approach and poor prognosis if untreated. It involves the deposition of amyloid proteins in the heart tissue, stiffening the heart and impairing its function.
- Acute Coronary Syndrome: In the context of new-onset heart failure, it's critical to rule out an acute coronary syndrome, such as a myocardial infarction, as prompt intervention can significantly improve outcomes.
- Pulmonary Embolism: While more commonly associated with acute right heart failure, large pulmonary emboli can lead to acute left heart failure in susceptible individuals, particularly if there's pre-existing left ventricular dysfunction.
Rare Diagnoses
- Fabry Disease: A genetic disorder that can lead to heart failure with reduced ejection fraction due to the accumulation of globotriaosylceramide in the heart tissue, among other systemic effects.
- Hemochromatosis: Iron overload can lead to cardiomyopathy and heart failure with reduced ejection fraction, although this is less common and typically associated with other systemic manifestations of iron overload.
- Sarcoidosis: This inflammatory disease can affect the heart, leading to cardiomyopathy and heart failure with reduced ejection fraction, though cardiac involvement is less common than pulmonary or other systemic manifestations.