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Cardiolucent

Condition

Heart Failure (HFrEF, HFpEF)

Guideline-directed management of heart failure with reduced or preserved ejection fraction.

Heart failure is a clinical syndrome in which the heart cannot meet the body's circulatory demands, leading to shortness of breath, fluid retention, and fatigue. It is divided by ejection fraction into HFrEF (heart failure with reduced ejection fraction, where the heart's pumping function is weakened) and HFpEF (heart failure with preserved ejection fraction, where the heart pumps normally but does not relax and fill properly). Modern, guideline-directed medical therapy has transformed the prognosis of HFrEF in particular, with several medication classes that each independently reduce mortality. HFpEF, long considered untreatable, now has effective therapies as well. Dr. Kedan provides comprehensive heart failure care with POCUS at every visit and personal management of medication titration.

What Cardiolucent Evaluates

  • Detailed symptom history and functional class assessment
  • Echocardiography with strain imaging to classify HFrEF vs HFpEF and identify contributing causes
  • POCUS at every visit for volume status and serial reassessment
  • EKG, biomarkers (NT-proBNP, troponin), and laboratory workup
  • Etiology evaluation: ischemic, hypertensive, valvular, infiltrative, genetic, or other
  • Guideline-directed medical therapy initiation and titration with personal follow-through
  • Coordination with electrophysiology and advanced heart failure specialists at Cedars-Sinai

Common Symptoms

  • Shortness of breath with exertion or when lying flat
  • Awakening at night short of breath (paroxysmal nocturnal dyspnea)
  • Swelling in the legs, ankles, or abdomen
  • Sudden weight gain from fluid retention
  • Fatigue and reduced exercise tolerance
  • Persistent cough or wheezing
  • Palpitations or new arrhythmias

Risk Factors

  • Coronary artery disease and prior heart attack
  • Long-standing hypertension
  • Valvular heart disease
  • Diabetes and obesity
  • Atrial fibrillation
  • Family history of cardiomyopathy
  • Chemotherapy or radiation history
  • Excess alcohol or certain recreational drugs
  • Sleep apnea and chronic lung disease

How Cardiolucent Approaches Treatment

HFrEF is treated with the four pillars of guideline-directed medical therapy: angiotensin receptor-neprilysin inhibitors (ARNIs) or ACE inhibitors/ARBs, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors. Each independently reduces mortality, and Dr. Kedan personally titrates them to target doses with attention to blood pressure, kidney function, and tolerability. HFpEF is treated with SGLT2 inhibitors, mineralocorticoid receptor antagonists in selected patients, and aggressive management of contributing conditions — particularly hypertension, atrial fibrillation, obesity, and sleep apnea. Diuretics are used in both forms to manage congestion. Cedars-Sinai is the referral center for advanced therapies when needed.

Common Questions

Frequently Asked Questions

What is heart failure?
Heart failure is a syndrome in which the heart cannot pump enough blood to meet the body's needs, or can only do so at the cost of high filling pressures. It causes shortness of breath, fluid retention, and fatigue. It is not the same as a heart attack, though heart attacks can lead to heart failure.
What is the difference between HFrEF and HFpEF?
HFrEF (reduced ejection fraction) means the heart's pumping function is weakened, typically with an ejection fraction below 40%. HFpEF (preserved ejection fraction) means the heart pumps normally but is stiff and does not relax to fill properly. The treatments differ, though there is significant overlap.
Is heart failure curable?
Heart failure is generally a chronic condition that requires ongoing management, but modern therapy has transformed outcomes. Some causes of heart failure are reversible, including alcohol-related cardiomyopathy, peripartum cardiomyopathy, and stress cardiomyopathy. For most chronic heart failure, the goal is meaningful symptom relief and extended life expectancy.
What are the four pillars of HFrEF therapy?
ARNI (or ACE inhibitor/ARB), beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor. Each independently reduces mortality in HFrEF, and the combined benefit is substantial. Dr. Kedan titrates each to target doses based on tolerance and response.
Why are SGLT2 inhibitors used in heart failure?
SGLT2 inhibitors, originally developed as diabetes medications, reduce hospitalizations and mortality in both HFrEF and HFpEF — independent of diabetes status. They are now a core part of heart failure therapy.
What is ejection fraction, and why does it matter?
Ejection fraction is the percentage of blood the left ventricle pumps out with each beat. A normal value is around 55–70%. It is one of the most important measurements in heart failure because it guides treatment selection and risk stratification, though it is not the whole picture.
What can I do at home to manage heart failure?
Daily weights, sodium restriction (typically 2 grams per day), fluid awareness, medication adherence, regular gentle exercise, and prompt reporting of weight gain, swelling, or increased shortness of breath are central to home management. Dr. Kedan helps build the specific routine that works for you.
When is a defibrillator or pacemaker needed?
Implantable cardioverter-defibrillators (ICDs) are recommended for selected patients with HFrEF and ejection fraction at or below 35% despite optimal medical therapy, to reduce sudden cardiac death risk. Cardiac resynchronization therapy is an additional option for those with specific EKG patterns and persistent symptoms. These decisions are made jointly with electrophysiology.
Will I need a heart transplant or LVAD?
Advanced therapies like heart transplantation or left ventricular assist devices (LVADs) are reserved for the most severe heart failure that does not respond adequately to medical therapy. Most patients with heart failure never reach this stage. When advanced therapy becomes relevant, referral is made to the advanced heart failure program at Cedars-Sinai.
How do I schedule a consultation?
Call (310) 304-5555 or use the contact form to schedule with Dr. Kedan at the Beverly Hills office. Cardiolucent does not bill Medicare or insurance; a detailed superbill is provided for any out-of-network reimbursement.

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Medical Disclaimer

The information on this site is for general educational purposes only and is not medical advice, diagnosis, or treatment. Reading this site does not create a doctor–patient relationship. Always consult a qualified healthcare professional for personal guidance. If this is an emergency, call 911. Mentions of medications, devices, or procedures are informational and not endorsements. Full medical disclaimer.

†Some listed indications involve investigational/off-label use. Learn more.