The CardioNerds and Dr. Shelley Zieroth Discuss Heart Failure Stage Classification

CardioNerds correspondents Drs. Adriana Mares and Christabel Nyange are joined by expert faculty Dr. Shelley Zieroth to assess the following heart failure question:

A 50 year old woman presents to establish care. Her medical history includes COPD, prediabetes, and hypertension. She is being treated with chlorthalidone, amlodipine, lisinopril, and a tiotropium inhaler. She denies chest pain, dyspnea on exertion, or lower extremity edema.

On physical exam, blood pressure is 154/88 mmHg, heart rate is 90 beats/minute, and respiration rate is 22 breaths/minute with an oxygen saturation of 94% breathing ambient room air. BMI is 36 kg/m². Jugular venous pulsations are difficult to assess due to her body habitus. Breath sounds are distant, with occasional end-expiratory wheezing. Heart sounds are distant, and extra sounds or murmurs are not detected. Extremities are warm and without peripheral edema. B-type natriuretic peptide level is 28 pg/mL (28 ng/L).

A chest radiograph shows increased radiolucency of the lungs, flattened diaphragms, and a narrow heart shadow consistent with COPD. An electrocardiogram shows evidence of left ventricular hypertrophy. The echocardiogram showed normal LV and RV function with no significant valvular abnormalities.

In which stage of HF would this patient be classified?

To answer the question, the CardioNerds and Dr. Zieroth refer to Sections 2.1 and 4.2 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.