Heart failure with preserved ejection fraction: Echocardiographic VALVE protocol for emergency physicians

Heart failure with preserved ejection fraction, previously called diastolic heart failure, has been recognized to account for heart failure in about half the total population of patients with heart failure. These patients can present with the signs and symptoms of acute heart failure. The emergency physician evaluating a patient for acute heart failure may find normal qualitative left ventricular systolic function on focused bedside echocardiogram and prematurely abandon heart failure as a differential diagnosis, when in fact signs of diastolic dysfunction could have been found on additional echo evaluation. This article discusses basic echocardiographic principles of diastolic dysfunction that can be learned and implemented in the emergency department. These findings can aid in the recognition of patients who present with heart failure with preserved ejection fraction. The authors will discuss a focused stepwise approach, namely the VALVE protocol, suitable for the fast-paced emergency department.