Decreased LV Systolic Funciton (HFrEF)

Your Path

  • Decreased LV Systolic Funciton (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, HIV, acute bacterial infection, chaga's disease, lyme
  • Autoimmune: lupus-related, giant cell myocarditis
  • Stress: Takotsubos
  • 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


  • SOB, DOE
  • PND, Orthopnea
  • Leg swelling
  • Sudden death
  • Chest pain/pressure
  • Lightheadedness, presyncope or syncope

Physical Exam Findings

  • + S3
  • Elevated jvp
  • Displaced lmi
  • Rales on lung exam
  • May have lower extremity edema and/or cool/mottled distal extremities w/delayed capillary refill (depending on whether concomitant volume overload, chronicity, ability to compensate)