Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; this may be measured by echocardiography or cardiac catheterization. Approximately half of people with heart failure have preserved ejection fraction, while the other half have a reduction in ejection fraction, called heart failure with reduced ejection fraction (HFrEF).Risk factors for HFpEF include hypertension, hyperlipidemia, diabetes, smoking, and obstructive sleep apnea. HFpEF is characterized by abnormal diastolic function: there is an increase in the stiffness of the left ventricle, which causes a decrease in left ventricular relaxation during diastole, with resultant increased pressure and/or impaired filling. There is an increased risk for atrial fibrillation and pulmonary hypertension. There is controversy regarding the relationship between diastolic heart failure and HFpEF. Signs and symptoms
Clinical manifestations of HFpEF are similar to those observed in HFrEF and include shortness of breath including exercise induced dyspnea, paroxysmal nocturnal dyspnea and orthopnea, exercise intolerance, fatigue, elevated jugular venous pressure, and edema.Patients with HFpEF poorly tolerate stress, particularly hemodynamic alterations of ventricular loading or increased diastolic pressures. Often there is a more dramatic elevation in systolic blood pressure in HFpEF than is typical of HFrEF. Risk factors
Diverse mechanisms contribute to the development of HFpEF, many of which are under-investigated and remain obscure.
The Shope papilloma virus can cause rabbits to grow horns. This may have been the source of myths such as the Wolpertinger and the Jackalope. See also
Wart
Actinic keratosis
Epidermodysplasia verruciformis
List of cutaneous conditions

References
Further reading
Matthew Moore (2007-11-12). "Tree man who grew roots may be cured". London: Daily Telegraph. Archived from the original on 2007-11-13. Retrieved 2007-11-14. "Images of cutaneous horns". DermAtlas. Archived from the original on 2003-04-19. Retrieved 2007-11-14. DiClaudio, Dennis (2006) "The Hypochondriacs Pocket Guide to Horrible Diseases You Probably Already Have", Bloomsbury Publishing, ISBN 978-1-59691-061-4


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