Heart Failure with Reduced Ejection Fraction (HFrEF)

Introduction

Heart Failure with Reduced Ejection Fraction (HFrEF) is a condition where the heart's ability to pump blood is impaired, leading to insufficient circulation to meet the body's needs. The ejection fraction (EF) is a key measurement used to define this condition. Normally, the heart's left ventricle ejects 50% or more of its blood volume with each beat. In HFrEF, this percentage drops below 40%.

Causes of HFrEF

HFrEF can develop due to various underlying factors, including: - Coronary artery disease (CAD): The most common cause, often due to prior heart attacks. - Hypertension (high blood pressure): Over time, it weakens the heart muscle. - Dilated cardiomyopathy: A disease causing the heart muscle to enlarge and weaken. - Valvular heart disease: Faulty heart valves increase strain on the heart. - Myocarditis: Inflammation of the heart muscle, often due to viral infections.

Symptoms of HFrEF

Patients with HFrEF may experience: - Shortness of breath (dyspnea), especially during activity or lying down. - Fatigue and weakness. - Swelling in the legs, feet, or abdomen (edema). - Persistent coughing or wheezing (due to fluid buildup in the lungs). - Rapid or irregular heartbeat. - Difficulty concentrating or confusion (due to poor circulation to the brain).

Diagnosis

Doctors diagnose HFrEF using: - Echocardiogram (Echo): Measures ejection fraction. - Electrocardiogram (ECG): Detects heart rhythm abnormalities. - Blood tests: Identify biomarkers like brain natriuretic peptide (BNP), elevated in heart failure. - Chest X-ray: Checks for heart enlargement and lung congestion. - Cardiac MRI or CT scan: Provides detailed heart imaging.

Treatment of HFrEF

1. Medications:

• ACE inhibitors / ARBs / ARNIs: Help relax blood vessels and reduce strain on the heart.
• Beta-blockers: Slow the heart rate and improve heart function.
• Diuretics: Reduce excess fluid buildup.
• Aldosterone antagonists: Help the body eliminate extra salt and water.
• SGLT2 inhibitors: Newer drugs improving heart function.

2. Lifestyle Changes:

• Reduce salt intake: Helps decrease fluid retention.
• Exercise regularly: Aids in maintaining heart strength.
• Quit smoking and limit alcohol: Helps prevent further heart damage.
• Monitor weight: Rapid weight gain can indicate fluid buildup.

3. Device Therapy and Surgery:

• Implantable cardioverter-defibrillator (ICD): Prevents sudden cardiac death.
• Cardiac resynchronization therapy (CRT): Helps coordinate heart contractions.
• Heart transplant or mechanical assist devices: For severe cases.

Conclusion

Heart failure with reduced ejection fraction is a serious but manageable condition. Early diagnosis, proper treatment, and lifestyle modifications can significantly improve patients' quality of life and prognosis. If you suspect any symptoms, consult a healthcare provider promptly.

Source recommendations

1. American Heart Association Guidelines for the Management of Heart Failure

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://professional.heart.org/en/guidelines-and-statements
3. https://www.heart.org/en/health-topics/heart-failure
4. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx
5. https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure

2. European Society of Cardiology Guidelines for Acute and Chronic Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
4. https://pubmed.ncbi.nlm.nih.gov/34447992/
5. https://academic.oup.com/eurheartj/article/44/37/3627/7246292