10 Heart Conditions That Present Differently in Women

6. Heart Failure with Preserved Ejection Fraction - The Stiff Heart Syndrome

Heart failure with preserved ejection fraction (HFpEF), also known as diastolic heart failure, represents a complex cardiovascular condition that affects women twice as often as men and presents unique diagnostic and therapeutic challenges. Unlike systolic heart failure where the heart's pumping function is obviously impaired, HFpEF involves a heart that appears to pump normally on standard tests but has become stiff and unable to relax properly between beats. This stiffness prevents the heart from filling adequately with blood, leading to symptoms of heart failure despite a normal ejection fraction on echocardiography. Women with HFpEF often present with exercise intolerance, shortness of breath, fatigue, and leg swelling, but these symptoms may be attributed to aging, deconditioning, or obesity rather than recognized as signs of serious heart disease. The condition is particularly common in postmenopausal women and is strongly associated with hypertension, diabetes, obesity, and atrial fibrillation. The pathophysiology involves changes in the heart muscle at the cellular level, including increased collagen deposition and altered calcium handling, which may be influenced by hormonal changes and inflammatory processes more common in women. Diagnosis requires specialized testing including tissue Doppler imaging, brain natriuretic peptide levels, and sometimes invasive hemodynamic assessment. The condition is particularly frustrating because, unlike systolic heart failure, there are fewer proven treatments available, and the prognosis can be as poor as or worse than systolic heart failure, yet it receives less attention in clinical practice and research.