Heart Failure With Reduced Ejection Fraction (HFrEF)

Multiple potential etiologies as described below.

Your Path

  • Heart Failure with Reduced Ejection Fraction (HFrEF)


  • Coronary artery disease: post-MI or hibernating myocardium for active ischemia
  • Hypertension related: chronic sub-optimally treated or hypertensive emergency
  • Valvular heart disease: aortic stenosis, aortic insufficiency, mitral regurg, mitral stenosis
  • Infection: viral myocarditis, endocarditis, HIV, acute systemic bacterial infections, chaga's disease, lyme
  • Autoimmune: lupus-related, giant cell myocarditis
  • Endocrine/metabolic: hypo or hyperthyroidism, thyroid storm, pheochromocytoma, growth hormone excess
  • Stress: Takotsubos, post-partum cardiomyopathy
  • Meds or toxins: anthracylcine or cyclophsophamide based chemotherapy; cocaine, crystal meth, alcohol
  • Hypertrophic cardiomyopathy, including sub-aortic stenosis
  • Restrictive or infiltrative cardiomyopathy: sarcoid, amyloidosis, hemochromatosis
  • Rhythm related: chronic tachycardia (e.g. poor rate control w/a fib); bradycardia
  • Idiopathic dilated cardiomyopathy


  • Orthopnea
  • PND
  • Doe
  • Sob

Physical Exam Findings

  • + S3
  • Elevated jvp
  • Displaced pmi
  • Lower extremity edema
  • Rales on lung exam