A 64-year-old female with long-standing poorly controlled hypertension presents with acute dyspnea, orthopnea, and bilateral crackles up to the mid-lung fields. Echocardiography demonstrates a left ventricular ejection fraction (LVEF) of 62% with marked left ventricular concentric hypertrophy and abnormal diastolic relaxation. What is the diagnosis?

Answer and explanation

Correct answer: D. Heart failure with preserved ejection fraction (HFpEF)

  1. Step 1: Analyze symptoms: Classic symptoms of pulmonary venous congestion and fluid overload (dyspnea, orthopnea, pulmonary crackles).
  2. Step 2: Analyze cardiac imaging: Left ventricular ejection fraction is (preserved systolic pump function), with evidence of diastolic dysfunction and structural hypertrophy.
  3. Step 3: Conclude diagnosis: Heart failure with preserved ejection fraction (HFpEF).
Answer
Heart failure with preserved ejection fraction (HFpEF).
Why not the others: 'Heart failure with reduced ejection fraction (HFrEF)' requires an LVEF ; 'Pulmonary embolism' typically features clear lungs on auscultation and right heart strain; 'Pulmonary arterial hypertension' presents with right heart failure without left-sided pulmonary edema crackles.

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