HFrEF vs HFpEF

Dimension	HFrEF	HFpEF
Core physiology	Weak pump: impaired systolic emptying, EF below 40%	Stiff pump: impaired filling with EF at or above 50%
Typical patient	Prior infarction or dilated cardiomyopathy	Older, hypertensive, often with obesity, diabetes, AF
Exam signature	Displaced apex, S3	Non-displaced apex, S4 more typical
Echo	Reduced EF, dilated LV	Preserved EF, diastolic indices, atrial enlargement
Congestion	Identical in both: JVP, crackles, edema	Identical in both: JVP, crackles, edema
Treatment principles	Disease-modifying quadruple therapy improves survival	Comorbidity and volume management; SGLT2 inhibitors benefit both

Pearls

Congestion cannot distinguish them; the ejection fraction and its company can.
Decompensation triggers (AF, ischemia, nonadherence, infection) deserve naming in every admission.

Connected