Past Health Problems Complicate HFpEF, a Complex Heart Condition

Heart failure with preserved ejection fraction is unique to each individual, requiring a personalized treatment plan and closely monitored care.

7:00 AM

Author | Jane Racey Gleeson

Multiple factors can lead to heart failure with preserved ejection fraction (HFpEF), a condition in which the heart muscle pumps blood normally but still doesn't meet the body's nutrition and oxygen requirements.

MORE FROM MICHIGAN: Sign up for our weekly newsletter

Ingeborg Ludeking knows this all too well.

Atrial fibrillation, pulmonary hypertension, an enlarged heart and sleep apnea were among the conditions on a long list of health concerns for the 78-year-old.

Her case isn't unusual. Most patients with HFpEF — pronounced "hef-pef" — also have several other illnesses, says Scott Hummel, M.D., M.S., who directs the University of Michigan Frankel Cardiovascular Center's HFpEF program along with Matthew Konerman, M.D.

"HFpEF develops when one or more chronic medical conditions gradually change the structure and function of the heart and blood vessels," says Hummel. "These changes stiffen the heart and make it more difficult for the heart to fill appropriately, thus limiting the amount of blood pumped with each beat."

Despite Ludeking's many health challenges, the resident of Clinton Township, Michigan, was able to enjoy a relatively active life until four years ago, when she began finding it difficult to breathe.

"I couldn't take more than 10 steps before having to stop to catch my breath," she recalls.

Warning signs

HFpEF symptoms often include:

  • Chest discomfort

  • Decreased exercise tolerance

  • Fatigue

  • Shortness of breath with exertion or while at rest

  • Swelling in the lower extremities

Risk factors

Underlying conditions or factors associated with HFpEF include:

  • Aging

  • Anemia

  • Atrial fibrillation

  • Chronic kidney disease

  • Chronic obstructive pulmonary disease (COPD)

  • Coronary artery disease

  • Diabetes

  • Hypertension (high blood pressure)

  • Inflammatory or autoimmune diseases

  • Obesity

  • Sleep apnea

A heart catheterization in 2015 confirmed Ludeking's HFpEF diagnosis. Her HFpEF risk factors were high, says Hummel, noting that the condition is becoming more widespread as the country's population ages and the associated risk factors become more common.

Treatment for HFpEF

Hummel says treatment for most patients with HFpEF includes controlling blood pressure and reducing excess fluid in the body that can cause swelling or shortness of breath.

SEE ALSO: How to Avoid a Heart Attack While Shoveling Snow

That isn't always enough, however. And reactive measures are often unique to the individual.

"HFpEF is a very complex illness, and there isn't one treatment that works for all patients," Hummel says. "When a patient is diagnosed, we have to sort through the individual aspects of the underlying conditions that contribute to it. We often also use information from diagnostic tests such as echocardiography, heart catheterization, stress testing and cardiac MRI to design the best treatment plan for each patient's particular situation.

"We promote lifestyle modification, including exercise and dietary interventions, which can improve quality of life in HFpEF patients. Each of our patients has a nurse case manager assigned to monitor and support them, and direct pager access to the physician directing his or her care," says Hummel.

A place in her heart

Ludeking was treated with diuretics to reduce the fluid affecting her heart and lungs, beta-blockers to keep her heart rate stable and blood thinners to prevent stroke. Her treatment protocol has proved successful.

"Dr. Hummel and his team have made a big difference in my well-being. I feel better today than I've felt in a long time," says Ludeking, who keeps active by riding a stationary bike, tending to her yard and cleaning her home.

"U-M has a special place in my heart," she says.

Photos by Leisa Thompson

More Articles About: Heart Health Heart Failure Interventional cardiology Cardiovascular: Diseases & Conditions
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories watch on hand
Health Lab
Tailored text messages not enough to improve mobility after heart issues
A Michigan Medicine report shows that adding a mobile health application to such devices yields mixed results. Tailored text messages to encourage high-risk people to move more may improve some short-term outcomes but doesn’t always improve physical activity levels for everyone.
man smiling sitting
Health Lab
A unique collaboration helps one patient better manage aortic disease
MI-AORTA is a donor-funded initiative that facilitates collaboration within the Frankel Cardiovascular Center, U-M Health and referring provider networks, creating value for the patients, families, and communities they serve and allows them to continue to pioneer advanced therapies for aortic diseases.
man standing
Health Lab
Beating the odds against chronic total occlusion
Learn about the latest advances in treatment for chronic total occlusion, a life-threatening condition that deprives the heart of oxygen. A team of cardiovascular surgeons perform advanced, minimally invasive surgery to help David Schneider get his life back on track.
Health Lab
Pulmonary embolism deaths, disparities high despite advancements in care
Despite these innovations, a Michigan Medicine study finds that the death rate for pulmonary embolism remains high and unchanged in recent years – more often killing men, Black patients and those from rural areas. The results are published in the Annals of the American Thoracic Society.
hospital staff emergency room patient rush
Health Lab
Nearly three-quarters of stroke patients requiring higher level of care wait over two hours for transfer
More than 70% of people experiencing a stroke who require a transfer wait longer than two hours to be transferred from the initial emergency department to hospitals with higher levels of care to receive time-sensitive care, a study finds.
cartoon of hospital workers and patient
Health Lab
Children who suffer cardiac arrest more likely to survive at ECMO capable hospitals
Children who experience cardiac arrest are one and a half times more likely to survive at a hospital capable of providing the life support system called ECMO, research suggests. But the reason behind better outcomes may have less to do with being saved by the heart and lung support machine itself and more to do with the care team structure at hospitals capable of ECM0, suggests the findings in Resuscitation.