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What Ejection Fraction Is Heart Failure

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What Is Ejection Fraction

Drugs for Heart Failure with Preserved Ejection Fraction

Ejection fraction is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. An ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out with each heartbeat.

This indication of how well your heart is pumping out blood can help to diagnose and track heart failure.

What Are The Types Of Heart Failure

There are many causes of heart failure, but the condition is generally broken down into two types:

Heart failure with reduced left ventricular function The lower left chamber of the heart gets bigger and cannot squeeze hard enough to pump the right amount of oxygen-rich blood to the rest of the body.

Heart failure with preserved left ventricular function The heart contracts and pumps normally, but the bottom chambers of the heart are thicker and stiffer than normal. Because of this, the ventricles can’t relax properly and fill up all the way. Because there’s less blood in the ventricles, less blood is pumped out to the rest of the body when the heart contracts.

What Is The Ejection Fraction For Heart Failure

The ejection fraction for heart failure is a number used to determine how effectively a patient’s heart is pumping. An ejection fraction of 55 percent is an indication that the heart is working well. Patients with a ejection fraction number under 40 may be in heart failure and need medical treatment to improve this organ’s function. A doctor can order tests and suggest a course of treatment that may include lifestyle changes and medications if heart failure is confirmed.

The heart works like a pump inside the body to keep organs, muscles and cells supplied with oxygenated blood. A normal heart beat has a “ka-thump” rhythm, which indicates the muscle contracting and then relaxing in between beats. When the heart muscle contracts, this movement pushes blood out of the ventricles, which are the large lower chambers of this organ. The ventricles fill up with blood again when the heart is relaxing.

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Different Conditions And Types Of Heart Failure

Coronary artery disease is one condition that can cause heart failure. Others include heart attacks, kidney disease, kidney failure, lung diseases like COPD and cystic fibrosis, heart valves that do not open or close properly, etc.

When the left ventricle becomes a weaker pump, it has a hard time pushing out all of the blood that collects inside of it. When this happens it is diagnosed as left ventricular heart failure, or left heart failure. Often times it is simply referred to as heart failure.

Sometimes this affects the ejection fraction but not always, giving us two different types of left heart failure. Knowing the difference between the two is important because both have different treatments.

Summary Of Treatment Recommendations

Types of Heart Failure

Patients with HFpEF and symptoms of volume overload should be treated with diuretics.31 Hypertension should be treated according to appropriate guidelines.3 Although RCTs of several medications showed fewer heart failure hospitalizations, this benefit was offset by increases in hospitalizations for other reasons. Thus, in the absence of hypertension, the evidence does not support treating patients with HFpEF with any medication except diuretics. Additionally, RCTs of angioten-sin receptor blockers, nitrates, and spironolactone raise concerns about adverse effects, and physicians should avoid using these medications, if possible.18,2325 Similarly, physicians should avoid the use of digoxin in patients 65 years and older.27 Physicians should consider referring patients with HFpEF who can exercise safely for exercise training or cardiac rehabilitation. Comorbid atrial fibrillation or CAD should be treated.

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Treat Any Known Causes Of Heart Failure

Find out if your HF is clearly linked to an underlying cause. Several risk factors are associated with heart failure like high blood pressure, or hypertension, diabetes and metabolic syndrome. By managing those conditions, you may be able to help your heart failure and your ejection fraction improve.

Know your plan and follow it carefully. If you have been prescribed medications for heart failure, diabetes, high blood pressure or another underlying cause, taking your prescribed medication may also improve your ejection fraction. Over time, as the medications are working, your heart may be able to recover, strengthen and perform better.

What Is Heart Failure

The term “heart failure” can be frightening. It doesn’t mean the heart has “failed” or stopped working. It means the heart doesn’t pump as well as it should.

Heart failure is a major health problem in the United States, affecting about 5.7 million Americans. About 550,000 new cases of heart failure occur each year. It’s the leading cause of hospitalization in people older than 65.

If you have heart failure, you’ll enjoy better health and quality of life if you take care of yourself and keep yourself in balance. It’s important to learn about heart failure, how to keep in good balance, and when to call the doctor.

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Heart Failure With Mid

  • 1State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
  • 2Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China
  • 3Bioland Laboratory , Guangzhou, China
  • 4Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
  • 5Department of Cardiology and Pneumology, University Medical Center of Göttingen, Georg-August-University, Göttingen, Germany
  • 6State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China

Diagnosis By A Specialist

Ejection Fraction Measurement and Heart Failure

Quality statement

Rationale

Quality measures

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Data source:

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What the quality statement means for different audiences

Service providersHealthcare professionalsCommissionersAdults with symptoms of heart failure

Definitions of terms used in this quality statement

Specialist
  • a lead physician with subspecialty training in heart failure who is responsible for making the clinical diagnosis
  • a specialist heart failure nurse
  • a healthcare professional with expertise in specialist prescribing for heart failure.

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A Weaker Left Ventricle

Certain disease states can cause the left ventricle to become a weaker pump. One disease that can do this is coronary artery disease . This is where cholesterol and plaque build-up in your arteries, making arteries abnormally narrow.

This may eventually lead to a condition called hypertension, or high blood pressure. High blood pressure is caused by arteries that are constricted or narrow. When this happens, your heart has to work extra hard to pump blood through blood your arteries.

When this goes on over a period of many years, your heart can become larger than normal. Hypertrophy is the medical term of an enlarged heart. A hypertrophied heart is a weaker heart. It cannot pump as forcefully as it used to. So, this is what causes a condition we call heart failure.

What Are The Symptoms Of Heart Failure

There may be times that your symptoms are mild or you may not have any symptoms at all. This doesn’t mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe, and may come and go.

In general, heart failure gets worse over time. As it worsens, you may have more or different signs or symptoms. It is important to let your doctor know if you have new symptoms or if your symptoms get worse.

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Heart Failure With Preserved Ejection Fraction: Diagnosis And Management

JOHN D. GAZEWOOD, MD, MSPH, University of Virginia Health System, Charlottesville, Virginia

PATRICK L. TURNER, MD, Richmond, Virginia

Am Fam Physician. 2017 Nov 1 96:582-588.

Heart failure with preserved ejection fraction , also referred to as diastolic heart failure, is characterized by signs and symptoms of heart failure and a left ventricular ejection fraction greater than 50%. Heart failure associated with intermediate reductions in LVEF is also commonly grouped into this category.

WHAT IS NEW ON THIS TOPIC: HEART FAILURE WITH PRESERVED EJECTION FRACTION

A systematic review found that jugular venous distention, an S3 heart sound, and displaced apical impulse significantly increased the likelihood of heart failure.

In the absence of hypertension, evidence does not support treating heart failure with preserved ejection fraction with any medication except diuretics. Additionally, trials of angiotensin receptor blockers, digoxin, nitrates, and spironolactone raised concerns about adverse effects.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Physicians should obtain a brain natriuretic peptide or N-terminal probrain natriuretic peptide level for patients with possible heart failure if the diagnosis is uncertain.

HFpEF = heart failure with preserved ejection fraction.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

HFpEF = heart failure with preserved ejection fraction.

Heart Failure With Preserved Left Ventricular Function

How Can I Improve My Low Ejection Fraction?

With this type of heart failure, you have a preserved, or normal, ejection fraction. It occurs when your left ventricle doesnt relax properly.

This may be due to a thickened heart muscle or heart muscle stiffness. It can lead to less blood being pumped from your heart to the rest of your body.

Symptoms may include fatigue and shortness of breath during exercise. HFpEF can be the result of aging, diabetes, or high blood pressure.

As we age, our hearts do too. Heart walls thicken and lose some of their capacity to contract and relax as efficiently as they should.

But a low ejection fraction reading can also indicate some form of heart damage, including:

  • Cardiomyopathy.Cardiomyopathy is a weakening of the heart muscle caused by thickening or dilation of the heart muscle. This makes it harder for your heart to pump properly.
  • Heart attack and coronary artery disease. A heart attack occurs when one or more of your arteries become blocked, causing damage to the heart muscle. Coronary artery disease can narrow or block your hearts left and right arteries, making it more difficult for blood to flow to your heart.
  • Heart valve disease. This occurs when one or more of the valves in your heart dont open or close properly. This can disrupt the blood flow through your heart and body.

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Suggested Approach To Diagnosis

Patients presenting with symptoms concerning for heart failure should undergo clinical evaluation. If physical examination findings suggest heart failure or fulfill the clinical criteria for the MICE or Framingham rules, the patient should be referred for TTE.3,5 BNP or NT pro-BNP should be measured in patients who do not meet these criteria, and the patient should be referred for TTE if the BNP level is 35 pg per mL or greater, the NT pro-BNP level is 125 pg per mL or greater, or the score on the Netherlands rule is 13 or greater. TTE assessment of LVEF and diastolic function can confirm HFpEF5 .

Diagnosis of Heart Failure with Preserved Ejection Fraction

Figure 1.

Algorithm for diagnosis of heart failure with preserved ejection fraction.

Diagnosis of Heart Failure with Preserved Ejection Fraction

Figure 1.

Algorithm for diagnosis of heart failure with preserved ejection fraction.

Common Signs And Symptoms Of Heart Failure

It is very important for you to manage your other health conditions, such as diabetes, kidney disease, anemia, high blood pressure, thyroid disease and asthma or chronic lung disease. Some conditions have signs and symptoms that are similar to heart failure. If you have new or worsening non-urgent symptoms, tell your healthcare provider.

Read Also: Constrictive Heart Failure

Definitions Of Heart Failure

HF is a complex clinical syndrome in which abnormal heart function results in, or increases the subsequent risk of, clinical symptoms and signs of reduced cardiac output and/or pulmonary or systemic congestion at rest or with stress. While this has traditionally focused on patients with predominant left ventricular systolic dysfunction , there is an increased awareness of the syndrome spanning patients with acute and chronic HF, right-sided HF, and HF across a spectrum of ventricular or valvular function. We have refrained from using other terms, often older descriptive terms , unless a specific definition exists. The term stable is not considered to be clinically appropriate given the inherent risk for future clinical events. We have not adopted a staging system1 or alternative systems2 for describing HF.

Chronic HF is the preferred term representing the persistent and progressive nature of the disease. Acute HF is defined as a gradual or rapid change in HF signs and symptoms resulting in the need for urgent therapy. Advanced HF is the term often used clinically, yet has no widely-accepted definition. In the context of the guidelines, we have outlined some of the key considerations for this term in as it pertains to selecting advanced mechanical devices, transplant or palliative therapies.

Review After Changes In Medication

What Drives Heart Failure with Preserved Ejection Fraction?

Quality statement

Rationale

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Structure

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Process

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Data source:Data source:

What the quality statement means for different audiences

Service providersHealthcare professionalsCommissionersAdults with chronic heart failure

Definitions of terms used in this quality statement

Review when medication is changed
  • clinical assessment of functional capacity, fluid status, cardiac rhythm , cognitive status and nutritional status
  • review of medication, including need for changes and possible side effects
  • an assessment of renal function.

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Obstructive And Nonobstructive Hcm

In obstructive HCM, the wall between the two bottom chambers of the heart thickens. The walls of the pumping chamber can also become stiff. It may block or reduce the blood flow from the left ventricle to the aorta. Most people with HCM have this type.

In nonobstructive HCM, the hearts main pumping chamber still becomes stiff. This limits how much blood the ventricle can take in and pump out, but blood flow is not blocked.

Heart Failure With Preserved Ejection Fraction

In this condition, which is also called diastolic heart failure, the heart doesnt relax properly, reducing the efficiency of the circulation of blood.

This type of heart failure mainly occurs in people older than age 65. Its usually caused by underlying conditions, such as hypertension or diabetes. Heart disease caused by these conditions may lead to a thickening of the hearts walls.

Less commonly, heart failure with preserved ejection fraction is genetic, or inherited. This is known as hypertrophic cardiomyopathy, and it can affect people of all ages.

Heart failure with preserved ejection fraction may also be caused by restrictive cardiomyopathy. This occurs when the heart muscle or other parts of the heart become too rigid to relax, making it difficult for blood to fill these areas.

Heart failure with preserved ejection fraction occurs less commonly than dilated cardiomyopathy and hypertrophic cardiomyopathy. It can be caused by cancer treatments, such as chemotherapy or chest radiation. It may also be related to blood or liver diseases that produce abnormal proteins that harm the heart.

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Medication For Chronic Heart Failure With Reduced Ejection Fraction

Quality statement

Rationale

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Structure

Data source:

Process

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Outcome

Data source:Data source:

What the quality statement means for different audiences

Service providersHealthcare professionalsCommissionersAdults with chronic heart failure who have reduced ejection fraction

Definitions of terms used in this quality statement

Heart failure with reduced ejection fraction

Equality and diversity considerations

What Does Ejection Fraction Have To Do With Heart Failure

Weak coronary heart Ejection Fraction

My patients concerns about heart failure are usually, What is my prognosis? What are the treatments, like medication and surgery, that are available to me? But some people will ask me for their ejection fraction number if theyve read about it, or had it discussed with them. This is especially true if they want to know if its changing over time.

What is EF?

EF is one of many measurements of how well your heart works. It measures the active pump function of your heart when it contracts and pumps blood out of your heart and into your arteries.

Technically, EF is the percentage of blood that is ejected from your heart as it contracts. .

Mathematically, EF is the amount of blood pumped with each beat, divided by the amount of blood in the chamber when its filled.

Your heart has two phases for each heartbeat:

  • A filling phase
  • A contraction or emptying phase

Therefore, EF is the stroke volume/diastolic volume.

What does EF have to do with heart failure?

A low ejection fraction lets a doctor know that the active pumping phase of the heart isn’t working. It’s usually tied to some, but not all, types of heart failure.

Heart failure with a low EF is called “systolic” heart failure.

How is EF measured?

EF is usually measured, with an echocardiogram or cardiac ultrasound. It can also be measured during a heart angiogram and catheterization. Thats when catheters are put inside of you through an artery, into your heart chambers.

Other measurement techniques include:

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An Ejection Fraction Of 20 Percent Is Pretty Bad And If You Know Someone Whose Ef Is This Low Youll Wonder How Much Longer Their Survival Time May Be

Three Year Survival Rate of 20% Ejection Fraction

A report in the International Journal of Cardiology took a look at the survival of congestive heart failure patients with very low left ventricular ejection fraction.

Low LV EF means that the left ventricle does not pump properly, resulting in an inadequate supply of blood for the rest of the body.

The general rule is that a very low EF is a predictor of mortality.

The study by Niebauer et al looked at 99 patients who all had ejection fractions of equal to or less than 20 percent.

74 had ejection fractions of 11 to 20 percent. 25 had EFs of 10 percent or less.

The patients were followed up after three years at which point mortality came in at 74 percent.

However, it was determined that left ventricular ejection fraction was not a predictor of survival rate for these patients.

So what was? Peak VO2 which was measured at the beginning of the study. Peak VO2 turned out to be a strong predictor of mortality.

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