Heart failure with preserved ejection fraction (HFPEF) is a diagnosis encountered with increasing frequency in the aging population. We present a case of postoperative pulmonary edema in 63-year-old male with HFPEF. This patient highlights the gap in risk stratification with respect to diastolic heart failure.

1. Introduction

Heart failure with preserved ejection fraction (HFPEF), or diastolic heart failure (HF), refers to the clinical syndrome of HF coupled with evidence of diastolic dysfunction and is associated with significant mortality and morbidity [1]. The incidence of HFPEF has been variedly described between 30 and 50% among patients with heart failure [2]. The goals of care for perioperative management of these patients include maintenance of adequate preload, slower heart rate to accommodate for adequate diastolic filling time, and avoidance of hypertension to decrease the afterload to the left ventricle. The association of acute myocardial infarction with perioperative HFPEF is rare but can have disastrous consequences. We describe the case of acute HFPEF presenting as a harbinger of myocardial infarction in the perioperative period.