Acute on chronic heart failure with preserved ejection fraction

It can cause breathlessness, swelling and rapid loss of exercise tolerance as pressure rises and fluid backs up. It needs timely clinical assessment because symptoms may worsen quickly and the trigger may require specific treatment.

Ejection fraction describes the proportion of blood pushed from the main pumping chamber with each beat. A preserved value does not show how well the chamber relaxes or fills. A stiff heart may need higher pressure to fill, allowing fluid to collect in the lungs or tissues even when the squeezing measurement looks preserved.

An acute episode may follow infection, uncontrolled blood pressure, an irregular rhythm, reduced kidney function, excess salt or fluid, or interruption of medicines. Clinicians assess symptoms, examination findings, blood tests, heart rhythm and imaging to identify congestion and its cause.

Contact your heart-failure team promptly if breathlessness, ankle swelling or abdominal fullness is increasing, or if you need more pillows to breathe comfortably. Follow your agreed action plan, but do not independently double diuretics or stop heart and blood-pressure medicines unless that plan specifically directs you.

Treatment may include removing excess fluid and correcting the trigger. After stabilisation, take medicines as prescribed, keep follow-up appointments, follow personalised advice on salt and fluids, and record symptoms or body weight if your team has asked you to. Bring an updated medicine list to every review.

Call emergency services for severe breathlessness at rest, inability to speak comfortably because of breathing, blue or grey lips, fainting, new confusion, crushing chest pressure, or pink frothy sputum. Do not drive yourself if you are severely unwell.

Seek same-day medical advice for a clear increase in swelling, breathlessness on usual activity, waking short of breath, a fast or irregular heartbeat with weakness, much less urine, or dizziness that interferes with standing. These changes can signal congestion, an abnormal rhythm or reduced circulation and should be assessed rather than watched at home.

Ask what probably triggered the flare, whether your blood pressure or rhythm needs different management, and which daily changes should prompt a call. Confirm your target for fluid and salt intake, how to use any weight-based action plan, when kidney and electrolyte tests are due, and who to contact after clinic hours.