John Ryan, a cardiologist with University of Utah Health, never thought he would see his work reflected in his daughter’s holiday program. That is, before he heard her speak her line. For her part in the school’s production of “The Grinch,” Ryan’s daughter had to say, “But I think that the most likely reason of all may have been that his heart was two sizes too small.”

“We’ve all heard the Grinch story, but what people may not realize is that there is a condition that causes the heart to get smaller,” said Ryan. “It’s called heart failure with preserved ejection fraction (HFpEF) and it’s common form of heart failure as people get older.”

Heart failure with preserved ejection fraction happens when walls of the heart thicken and become too stiff to allow the organ to fill with blood. The heart then doesn’t fill with enough blood, and therefore doesn’t pump out enough blood to maintain the needs of the body. While the heart may not look smaller on the outside, the inside chambers do get physically smaller making it so the heart is doing the work of a much smaller organ.

“Patients with this type of heart failure may find themselves easily fatigued, with shortness of breath or chest discomfort,” said Ryan. “It may not only affect them physically, but mentally as well. They may find themselves depressed, or angry, or downright ‘Grinchy.’”

There are things people can do to reduce their risk of HFpEF. Keeping blood pressure in check is a good start. The majority of people with HFpEF suffer from hypertension. Maintaining a healthy weight, getting quality sleep and keeping conditions like diabetes and anemia in check can also help.

Christmas cheer isn’t enough to help the hearts of people with HFpEF but there are lots of treatments available. University of Utah Health has a clinic dedicated just to the treatment of this condition. “We work to get the heart to relax more so that it can fill with the proper amount of blood,” said Ryan. “We also have several clinical trials we are running, and work with multidisciplinary teams to find other interventions to help hearts work more effectively.”

While the heart won’t get bigger with proper treatment the increased blood flow will help patients feel like their heart has grown three sizes. Of course, you wouldn’t want your heart to actually suddenly expand. “That could make the heart too large,” said Ryan. “That would in another form of heart failure called dilated cardiomyopathy. The Grinch doesn’t want that!”