Have you ever heard the term 'Ejection Fraction'? You may have heard it from your doctor or a family member when they were talking about heart disease. It's actually a very important thing, and it's a measure of how healthy our heart is. So, today we'll talk in detail about what this 'Ejection Fraction' is and what it says about the health of our heart.
What is Ejection Fraction? Simply put...
Simply put, Ejection Fraction is a measure of how well your heart pumps blood. More precisely, it is the amount of blood that is ejected from the main chambers (also called the ventricles) at the bottom of the heart during each beat.
To understand this, let's briefly recall how blood flows through the heart:
1. Blood first enters the upper right part of the heart (this is called the `right atrium`).
2. Then, during the short pause between heartbeats, this blood passes through a valve and collects in the lower chamber (`left ventricle`) on the left side of the heart.
3. Now, when this left ventricle is filled with blood, with the next heartbeat, a portion of that blood is pumped out to the rest of the body. The amount of blood that is pumped out is what we measure by the ejection fraction.
What is the normal ejection fraction of a healthy heart?
The ejection fraction of a healthy, well-functioning heart should normally be between 50% and 70% . This means that when the heart beats once, between 50% and 70% of the blood in the left ventricle is pumped out to the body.
But there is also this. Some people may have a normal ejection fraction, but they may still have heart failure. We call this `Heart Failure with preserved Ejection Fraction (HFpEF)`. This means that even though the ejection fraction is good, the heart failure is caused by other problems in the heart.
Why is it important to know my Ejection Fraction?
Your Ejection Fraction is a key indicator of how well your heart is working. A low Ejection Fraction usually means you have or are at risk for heart failure. Therefore, knowing this value is very important for planning treatment and monitoring the condition of your heart.
Are there different types of Ejection Fraction?
Yes, this measurement can be taken mainly in both the left and right chambers (`ventricles`) of the heart.
Left Ventricular Ejection Fraction (LVEF)
We usually talk about the left side of the heart as Ejection Fraction. Because it is the left ventricle that pumps oxygen-rich, clean blood to the organs throughout the body. So, this `LVEF` value helps determine whether there is any weakness in the functioning of the left side of the heart, and if so, how severe it is.
Right Ventricular Ejection Fraction (RVEF)
This measures how much oxygen-poor, impure blood is pumped from the right ventricle of the heart to the lungs (where oxygen is re-oxygenated). This RVEF value is important if you have right-sided heart failure. However, this condition is not as common as left-sided heart failure.
What do Ejection Fraction values mean?
Simply put, the lower your Ejection Fraction, the weaker your heart's ability to pump blood. This is seen in people with severe heart failure. It can also be low in the early stages of heart failure. Treatment options depend on how far your Ejection Fraction is from normal.
- If it is between 40% and 49%: This is called a `mid-range ejection fraction`. This means that the heart's pumping ability is slightly lower than normal. You may not have any symptoms of heart failure. Or, symptoms may occur during periods of exertion, such as during exercise, and go away when you rest.
- 39% or less: This is called `Heart Failure with reduced Ejection Fraction (HFrEF)`. This means that the pumping ability is much lower than normal. The lower the ejection fraction, the higher the risk of life-threatening complications such as sudden cardiac arrest (`Cardiac Arrest`). Symptoms can be severe, and you may feel discomfort even just sitting down.
Can heart failure (HFpEF) occur even if the ejection fraction is normal?
Yes, as we mentioned earlier, in the condition called `Heart Failure with preserved Ejection Fraction (HFpEF),` the heart pumps a large amount of blood to the body when it beats. However, the problem is that the total amount of blood that is stored in the left ventricle decreases. This is because the heart muscle thickens or stiffens, which reduces the size of the chamber. Then, the body cannot pump as much blood as it needs.
You may be at risk of developing HFpEF for the following reasons:
- Cardiac Tamponade (fluid accumulation around the heart)
- Coronary Artery Disease
- Heart Valve Disease
- High Blood Pressure
What are the causes of decreased ejection fraction?
Healthy heart muscle fibers are needed for the heart's ventricles to contract and pump blood out. If there is a condition that weakens or damages the heart muscle, this contraction does not occur properly, and the pumping efficiency is reduced.
The heart then has to work harder to do its job. This extra strain can cause the heart to swell or develop scar tissue. This makes it harder for the chambers to fill with blood and pump blood. Even if your ejection fraction is slightly reduced, you may not notice much difference at first. But if your heart's function gradually decreases and your ejection fraction gets worse, you can become seriously ill.
What are the symptoms of a low ejection fraction?
In general , the lower the ejection fraction, the more severe the symptoms of heart failure. You may experience things like:
- Confusion: Difficulty thinking clearly.
- Fatigue: Feeling tired even when just being at work.
- Heart palpitations: A feeling of pounding or pounding in the chest.
- Nausea.
- Dyspnea: Difficulty breathing, especially when lying down.
- Water retention: A condition where the abdomen or legs become swollen with water.
- Weakness.
Remember, if you have these symptoms, it is very important to seek medical advice immediately.
What if the Ejection Fraction is higher than normal?
It is very rare for an ejection fraction to be 75% or higher. But if it does happen, it can be dangerous. This can happen to people with conditions like `Hypertrophic Cardiomyopathy` (abnormal thickening of the heart muscle).
Whose ejection fraction should be measured?
If you have a disease or risk factor that could lead to heart failure, knowing your ejection fraction is very useful. In cases like these:
- Diseases like `ATTR Amyloidosis` that affect the heart.
- Some chemotherapy treatments for cancer or other diseases can cause damage to the heart (cardiotoxicity).
- Congenital Heart Disease.
- If you have a heart attack.
- Heart Valve Disease.
- Myocarditis.
- Severe high blood pressure.
- Irregular heartbeat of the heart chambers (`Ventricular Arrhythmia`).
How is Ejection Fraction used for treatment?
This value helps doctors choose the best heart failure treatment for you. Also, checking your ejection fraction periodically throughout your treatment can help determine if your heart function is improving.
Some of the main heart attack treatments are:
- A special type of pacemaker (`Biventricular pacemaker`).
- Heart failure medications.
- Heart transplant.
- Heart valve repair or replacement.
- Implantation of a small device in the body that delivers an emergency electric shock to the heart (Implantable Cardioverter Defibrillator - ICD).
How is Ejection Fraction measured?
There are several ways to measure ejection fraction. The most commonly used test is an echocardiogram, which is like an ultrasound scan of the heart.
In addition, these tests can also measure ejection fraction:
- Cardiac Catheterization.
- A `CT` scan of the heart (`Cardiac Computed Tomography (CT) scan`).
- Heart MRI.
- `MUGA` scan (`Multigated Acquisition Scan`), also called `Nuclear Stress Test`.
Can I improve my Ejection Fraction?
Yes, absolutely. Heart failure therapies treat the underlying cause of the low ejection fraction. For example, if the low ejection fraction is due to an irregular heartbeat (arrhythmia), a biventricular pacemaker may provide relief. If it is due to other causes, such as high blood pressure, medications may be needed.
Also, you can do the following to reduce the strain on your heart and get the most out of your treatment:
- Increasing physical activity: A cardiac rehabilitation program can help you safely begin exercising.
- Maintaining a healthy weight.
- Limiting salt (sodium) and fluids in the diet.
- Quitting harmful habits like smoking, drugs, and alcohol.
How do I know if my ejection fraction is improving?
If your ejection fraction is low, you will need to see your doctor more often to monitor it. It is important to attend all medical appointments, even if you do not feel sick.
If your symptoms are improving, it could be a sign that your ejection fraction is improving. However, your symptoms may get worse or new symptoms may appear. These could indicate that your ejection fraction is getting worse.
If something like this happens, inform your doctor immediately, without waiting for your next doctor's appointment:
- Difficulty breathing, especially when lying down.
- Feeling of unusually fast heartbeat.
- Loss of appetite or vomiting.
- Sudden weight change (this may be due to water retention).
- Weakness or dizziness felt for no reason.
How often should Ejection Fraction be measured?
Doctors may be concerned about your ejection fraction in the following situations:
- If you have symptoms of heart failure.
- If you have a heart attack or other condition that affects the functioning of the heart.
- If you suffer from a medical condition that increases your risk of heart disease.
How often you should have this test after you've been diagnosed with heart failure depends on a number of factors, including how low your initial ejection fraction is. If your ejection fraction continues to get worse, you may need to have it checked more often. If it's stable, you may not need to be tested as often.
Is Ejection Fraction the only test to assess the condition of Heart Failure?
No. Ejection fraction is just one of many measurements doctors use to assess the condition of your heart. Additional tests are needed to determine the exact cause of your condition and provide you with the most appropriate treatment.
These additional tests may include:
- Angiography.
- Chest X-ray.
- Echocardiogram.
- Electrocardiogram (`Electrocardiogram - EKG`).
- Exercise Stress Test.
Finally, things to remember (Take-Home Message)
Ejection Fraction is an important indicator of the strength of the heart. It measures how much oxygen-rich blood the heart pumps out into the body with each beat. A low ejection fraction is usually a sign of heart failure. But don't worry. With proper treatment and lifestyle changes on your part, it is often possible to bring your ejection fraction back to normal. The most important thing is to follow your doctor's instructions and attend regular checkups and appointments. This will go a long way in keeping your heart healthy.
` Ejection Fraction, Heart Attack, Heart Health, LVEF, RVEF, Heart Disease Symptoms, Heart Treatment
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