HFpEF

We have been sold on eating meat and drinking milk which is most unnatural for adult humans and creates many problems both for people and for the planet. But people eat what they like and not worry about health effects that take many years to manifest as a "disease".

In the past men died before they reached 70 and so they did not experience the same issues as men do today. My low ejection issue was not diagnosed until my 75th year and now I need to remodel my heart which is going to take months to accomplish. The determining right heart meds and dosages and daily exercise that elevates my pulse is my approach.

@katiekateny
Maybe you should go in person to a medical center that does advanced diagnostic tests (genetic, blood, invasive, exercise, CT, MRI)?

Greetings macconsulting2,
Sorry to hear you've been diagnosed with HFpEF, although getting the diagnosis is the first step to getting the right treatment. My experience has been that starting daplaglifozin (an SGLT-2i, not cheap at all) has made a big difference. It took a good month to see it, but it really helped. I'm also on a low dose of spironolactone, which is super cheap. That did wonders for my BP and has helped my potassium stay in a better range. In some people spironolactone makes the potassium go way too high, so you should do a few blood tests when you go on it. The third drug most people with HFpEF get put on is called an ARNI, Entresto (a bit expensive) being the brand name, or just plain old valsartan (pretty cheap). I'm on valsartan, but might try entresto this month. My BP is about 105/65 these days so I can't go too fast on new meds.

The GLP-1 are the new game in town. If you have an indication for starting them. they have been really effective. They are not cheap at all, but the prices have come down a bit.

As far as lifestyle, I have a lot of trouble with exercising kicking off afib. Controlling afib, if you have it, probably with ablation, is critical. I was ablated in May and have had 2 breakthrough episodes of afib, which made me sad. I used to have afib every 1-3 weeks so it was totally worth getting ablated. That being said, if I don't exercise I get depressed, so I walk that fine line, literally. I walk about 2.5 miles every day, really slowly with a few breaks. I do yoga, lift a bit of weight and sit and do one of those pedal things you see advertised on late night TV too. Sometimes I have days when I'm short of breath just walking a short distance, but not since I've been on the SGLT-2i. I still get short of breath walking what used to be my normal speed if I walk for more than 10 minutes.

The cause of my HFpEF was my first and hopefully last covid infection. I had well controlled hypertension for a few years prior to my HFpEF, an A1C of 5.7 and a BMI of 25, swam a 1/2 mile a day, biked a lot, hiked a lot, so not exactly high risk, but certainly some risk prior to Covid. I really think preventing Covid is smart for people with HF. I wear a mask when sharing air, I give away HEPA filters to my friends and family, and we all test at family gatherings if we aren't wearing masks. I had the XBB vaccine in October of 2024, which wasn't very protective in June of 2024 when KP2 was circulating. The vaccines are certainly helpful, but they aren't updating them fast enough to keep up with all the virus that flys around. The current shot is pretty good for now. I really like Novavax better than the mRNA shots, but if you don't get a fever and aches after an mRNA shot, they are fine. For sure get a flu shot, this year is going to be a doozy. I need to get an RSV shot one of these days too.

If your diagnosis is bumming you out like it did me, you might want to consider talking to someone. I did one visit with a medical social worker and it was really helpful. Friends and family don't really understand and it felt like I was dumping on them when I was feeling poorly. The social worker gave me a ton of homework, which I've not done since I'm feeling better now, but I should do that homework so I have some resilience tools for when my heart gets sad again.

I've been a vegetarian for 49 years, but ate more sweets than I should have. I've really improved my diet and wore a stelo, a continuous glucose monitor, a few times. That was an eye opener. The big change I made was I stopped eating Amy's soup for lunch and now eat a cup of beans I make in my instant pot with a splash of apple cider vinegar and Costco no salt herb stuff. I put about 20 grams of cheese on it to make me happy. I eat a carrot or some other veggie at lunch too. Amy's had too much salt and it shot my glucose up pretty fast. Probably the crackers didn't help. I eat 1/2 as much oatmeal as I used to and made up for the calories with walnuts and berries. It still bumps up my blood glucose but I sit on my pedal thing and doom scroll on my phone after breakfast, which controls it. My dinner hasn't changed too much, maybe a little more tofu and certainly less pasta and rice. I eat a bit of chocolate most days. What I found is food makes me happy, and depriving myself too much makes me sad. The glucose monitors can drive you nuts.

I know this is a lot. The good thing about getting diagnosed now instead of say, 5 years ago, is there is some good data on what works for HFpEF. You have to pay pretty close attention to your body now, which is a pain, but for me, knowledge is power. I really don't want to ever have to go back into the hospital, which isn't realistic, but I can hope!

This link is hard to read and has way too much information...
https://www.ncbi.nlm.nih.gov/books/NBK599960/
Good luck!

I have it, diagnosed in 2016. Might not have if doctors had had prescribed AND made me understand years before that my increasing blood pressure and cholesterol test results were something to take very seriously. I tried to convince them that the hs-CRP (highly sensitive C-reactive protein blood test results, going from 3 to 9 (maximum) in less than 2 years were something they should take seriously, because that's known to be "predictive" for heart failure. It took 2 years to get the "diastolic dysfunction" (HFpEF) diagnosis even when it was quite clear to me that something was wrong with my heart, and I kept telling them so.

Then it took until 2021 before a doctor put me on Losartan for BP and Atorvastatin for cholesterol. By 2023, a cardiologist I saw for only 15 minutes added Spironolactone, because my BP was still high. That stopped the edema that had developed in my feet.

Since then, all of that has been within normal range, and I haven't had any side effects. If you take Spironolactone, you do have to have be careful about not overeating things with potassium (banana, for example, but you can eat half of one occasionally) and have that level checked about every 6 months, because Spironolactone can increase it to hyperkalemia, and that's serious. I track my food in Cronometer, which shows me whether potassium that day is within the range I set or the software sets, and I haven't had a problem, so far. I am reasonably careful, though.

People can live 20 years, maybe more, with it if they have a good cardiologist and follow the doctor's directions -- and follow a heart-healthy diet. #1: No added salt! Some advise keep sodium to < 2000 mg a day, but I keep it < 1500 mg, nearly always. I use herbs, lemon juice and such for seasoning and don't miss the high salt that's in everything now at all. It's also very important to get your heart rate up -- EXERCISE -- every day or at least 5 days a week. DO NOT just sit around.

But here's the not-good part, which might or might not be related or affect you: I now have a "severely enlarged" L atrium and an "enlarged" R atrium (with new ECHO tomorrow -- dreading results), and I'm pretty sure those are related -- the heart failure is progressing. Plus 4 arrhythmias, 2 of which are scary. I'm beginning to feel like a med school class demo. But I'm 80, so I guess it goes with the territory, and I try to push the fears out of my mind (because that's a dark place and not at all helpful) and focus on nature and the good things that I can still enjoy. And I tell myself: "Accept. Adapt." and "One day at a time."