In contrast to SHF, which is easily diagnosed by signs or symptoms of fluid overload in the presence of a reduced LVEF (ie, LVEF <40%), the diagnosis of DHF is frequently challenging. Obvious signs of fluid overload such as lung crepitations, distended neck veins or pedal oedema are evident if the DHF patient presents in an emergency room with acute decompensated heart failure; however, the same physical signs are notoriously absent if the patient presents in an outpatient clinic with dyspnoea on exertion. Therefore, if the diagnosis of DHF is simply based on the presence of symptoms and a normal LVEF, physical deconditioning can erroneously be diagnosed as DHF. This high risk for a false …