A patient presents with shortness of breath, orthopnea, edema, elevated ProBNP, interstitial edema on chest imaging, preserved EF, and severe aortic stenosis. What additional condition could be considered?

• A. Acute diastolic congestive heart failure
• B. Acute kidney failure
• C. Pulmonary embolism
• D. Pneumonia

Answer: (A)

The situation points to heart failure with preserved ejection fraction due to diastolic dysfunction. When the ejection fraction is preserved, the pumping ability is normal, but the ventricle has reduced compliance and relaxation, so filling pressures rise. Severe aortic stenosis drives left ventricular hypertrophy, which makes the ventricle stiffer and worse at filling, promoting diastolic dysfunction. The raised ProBNP reflects elevated left-sided filling pressures, and the symptoms—shortness of breath, orthopnea, edema, and interstitial edema on imaging—fit pulmonary congestion from diastolic failure.

So, the additional condition to consider is acute diastolic congestive heart failure (acute decompensation of HFpEF) driven by diastolic dysfunction from the stiff, hypertrophied ventricle due to severe aortic stenosis.

Other possibilities like acute kidney failure, pulmonary embolism, or pneumonia don’t align as neatly with the combination of orthopnea, edema, interstitial edema, preserved EF, and the context of severe aortic stenosis.