Acute shortness of breath and chest tightness in an elderly patient: clinical history tells it best!

Almost 50% of patients presenting with heart failure have no systolic left ventricular dysfunction and thus are diagnosed with diastolic heart failure (HF). Diastolic HF reflects an increased sensitivity to volume status and vasoreactivity of patients with underlying diastolic dysfunction, a condition commonly observed in elderly patients with numerous comorbidities. In this case report, an example of the diagnostic and therapeutic challenges in a patient with diastolic HF is illustrated. Indeed, while defined international guidelines are available for patients with systolic HF, the management of diastolic HF patients is less well defined and largely dependent on patients’ characteristics.