Understanding Low Ejection Fraction (EF)

Introduction

Ejection fraction (EF) is a key measurement to assess the heart's pumping ability. It represents the percentage of blood the left ventricle pumps out with each heartbeat. A normal EF is typically 50-70% .

What Does a Low Ejection Fraction Mean?

A low EF (below 40% ) suggests that the heart is not pumping enough blood to meet the body's needs. This condition is often indicative of heart failure with reduced ejection fraction (HFrEF) .

Causes of Low Ejection Fraction

Several conditions can lead to a reduced EF: - Coronary artery disease (CAD) – Blocked arteries reduce blood supply to the heart muscle. - Myocardial infarction (heart attack) – Damage to heart muscle decreases its ability to contract. - Cardiomyopathy – Diseases that weaken the heart muscle. - Valvular heart disease – Faulty heart valves can overload the heart. - Uncontrolled hypertension – Chronic high blood pressure strains the heart. - Myocarditis – Inflammation of the heart muscle due to infection.

Symptoms of Low Ejection Fraction

Common symptoms include: - Shortness of breath (dyspnea), especially with activity or lying down. - Fatigue and weakness. - Swelling in the legs, ankles, and feet (edema). - Rapid or irregular heartbeat. - Persistent cough or wheezing (sometimes with white or pink mucus).

Diagnosis

Doctors use several tests to measure EF: - Echocardiogram – The most common test using ultrasound. - Cardiac MRI – Provides detailed images of the heart. - CT Scan – A specialized imaging tool. - Nuclear stress test – Evaluates blood flow. - Cardiac catheterization – Checks for blocked arteries.

Treatment Options

Lifestyle Modifications

• Dietary changes – Reduce sodium and fluid intake to ease heart strain.
• Exercise – Light physical activity as recommended by your doctor.
• Weight management – Reducing excess weight lowers heart workload.
• Smoking and alcohol cessation – Both negatively impact heart function.

Medications

• ACE inhibitors / ARBs – Help lower blood pressure and improve heart function.
• Beta-blockers – Reduce heart rate and workload.
• Diuretics – Help remove excess fluid and reduce swelling.
• Aldosterone antagonists – Protect the heart from further damage.
• SGLT2 inhibitors – A newer class of drugs improving heart failure outcomes.

Surgical or Device-Based Treatments

• Implantable cardioverter-defibrillator (ICD) – Prevents sudden cardiac death.
• Cardiac resynchronization therapy (CRT) – Helps improve heart contraction.
• Left ventricular assist device (LVAD) – A mechanical device for severe cases.
• Heart transplant – Considered in end-stage heart failure.

Conclusion

A low ejection fraction can be serious but manageable with proper medical care and lifestyle changes. Early diagnosis and appropriate treatment can improve quality of life and outcomes.

Source recommendations

1. American Heart Association Guidelines on Heart Failure Management

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/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure

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

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://pubmed.ncbi.nlm.nih.gov/34447992/
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
4. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
5. https://pubmed.ncbi.nlm.nih.gov/27206819/