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Ejection Fraction(EF)

Ejection fraction is used to indicate and diagnose heart failure based on how much blood the heart is pumping with each contraction. Typically, ejection fraction is used to estimate the strength of the heart.   

Ejection fraction is a percent factor that is derived through stroke volume (SV) and the end-diastolic volume (EDV). It is derived from how much blood remains in the left ventricle after a single beat is concluded, and this is subtracted from how much blood the heart adhered at the beginning of the beat.    

This measurement stands out to give the strength of the heart, and any variation in ejection fraction indicates heart problems. If fifty percent of blood remains in the ventricle after one beat, ejection fraction is expressed as fifty percent or the decimal value of 0.5.   

There are two ventricles in the heart, and the left ventricle usually measures ejection fraction. So, the ejection fraction is often called the left ventricular ejection fraction (LVEF).    

The left ventricular has more significance than the right ventricular as the right one draws oxygen-rich blood to the lungs, and the right ventricular ejection fraction is used in that sense.   

Importance of the ejection fraction!   

Ejection fraction is used to define the present strength of the heart. If the muscles are weak, they will not be able to contract the usual amount of oxygen-rich blood.

Importance of the ejection fraction!

If blood extraction is less, the heart will expand to hold more blood. This is also to allow for the typical heart stroke volume. Cardiomegaly is a term used to describe this unusual expansion of the heart. This is one of the first signs of card failure.

There are other heart conditions apart from cardiomegaly, for example, “cardiomyopathy” and the “CAD,” which are also the symptoms of heart failure.    

How to measure left ventricular ejection fraction?   

There is more than one way to measure ejection fraction, and all these techniques are administered depending on the patients’ symptoms.

How to measure left ventricular ejection fraction? 

Echocardiogram (echo)

Ultrasound is used to measure the heart’s ejection fraction in this case, which is a non-invasive way to monitor the heart’s health. Heart scans are generated during this procedure.

Cardiac Catheterization

A catheter is inserted through a blood vessel in the patient’s hand or leg, and a thin pipe is inserted into the heart. During this procedure, images are taken of the catheter as it is guided to their heart. Coronary angiography can also be done in this manner, and a dye is injected into the catheter.   

Cardiac Magnetic Resonance Imaging (C-MRI)

This procedure uses a magnetic field and wavelength to produce a 3D image of the heart. This one is quite detailed compared to others.   

Nuclear medicine scan (MUGA)

This is a relatively new technology that uses radioactive materials to be infused into circulation and recorded by cameras.

CT scan

Here, an X-ray gives an accurate image of the heart and its function.   

Nuclear Stress Scan (MPI)

This test is done on a treadmill or an exercise cycle and again while resting. The analysis also uses radioactive medicines to show the flow of blood and artery functions.   

Why is ejection fraction measured?    

Ejection fraction is often measured if some or all of the following symptoms are present:

  • Shortness of breath   
  • Swelling on the feet or the lower part of the legs   
  • Fatigue   
  • Rapid, low, uncomfortable, and irregular heartbeat   
  • Abdominal discomfort   
  • Nausea and weakness   
  • Agitation and lightheaded   
  • Exhaustion and exercise intolerance

The numbers for measuring left ventricle ejection fraction(EF)   

If you have a heart condition or heart failure, ejection fraction can identify these problems. Here is a summary of what the numbers may mean:

Ejection fraction 50%-70%   

The pumping ability of the heart is excellent. Although the heart’s pumping capacity may be healthy, it may have heart failure with preserved ejection fraction.

Ejection fraction 40%-50%   

Here pumping ability of the heart is below standard.   

This may not show the symptoms of heart failure, but blood has less oxygen, and less blood is pumped than the normal ejection fraction. 

Ejection fraction 35%-40%   

Here pumping ability of the heart is moderately below the normal range.   

Mild heart failure can occur.   

Ejection fraction lower than 35%   

Here pumping ability of the heart is severely less.   

Life-threatening heart conditions and cardia desynchronization are presumable.    

How does too high ejection fraction effects?    

If the percentage is more than 75%, a high ejection fraction might cause the stiffness of the heart muscle and lead to cardiac arrest. This condition is known as hypertrophic cardiomyopathy.    

How low ejection fraction effects?    

If the ejection fraction is lower than forty percent, it may lead to heart failure. This can also cause high blood pressure and heart valve failures, which can even damage the muscles.   

Diagnosis of heart failure   

There are two reasons to determine heart failure: preserved left ventricular heart failure and reduced left ventricular heart failure.    

Preserved ejection fraction (HF-pFE)   

If you are diagnosed with the preserved ejection fraction here, your left ventricle is discharging blood normally. But it can not fill with enough blood, which makes the heart muscle stiff and can not recline with time. The preserved ejection fraction can be diagnosed in people who have an ejection fraction of more than fifty percent. As the preserved left ventricular function decreases, the chances of heart failure also increase.

Preserved ejection fraction (HF-pFE)   

The heart has insufficient blood to pump, and the heart muscle of the left ventricle is thickened. And to compensate for this pattern, the heart will increase the pressure to fill in more blood. With time, blood can fill up the left atrium and even travel to the lungs. This leads to fluid congestion, and as a result, you have heart failure.    

Reduced ejection fraction (HF-rEF)   

There is a high possibility of heart failure due to reduced left ventricular function if you already have an ejection fraction of less than thirty-five percent. The ejection fraction usually contributes to how much blood one had inside their left ventricle after one beat. In this case, the left ventricle a small amount of blood after each beat.   

The ventricle is not pumping the usual blood volume, and then the body is getting a small quantity of blood. This can lead to life-threatening heart beating or sudden cardiac arrest with death.   

The causes of heart failure   

Heart failure may be caused by a variety of factors. However, heart diseases are increasingly prevalent as people age, or they may be the consequence of some medicine or just anxiety.

Coronary artery disease   

This is mainly known as a heart attack. There is a blockage in the coronary arteries that limits the flow of regular plumping blood. This weakens the heart muscles, and pumping blood is not enough for the body. So, this leads to a reduced ejection fraction.   

Sometimes low blood flows make the muscles stiff, leading to preserved ejection fraction and heart failure.    

Cardiomyopathy   

This weakens the heart muscles and reduces the blood pressure after one contraction.   

High blood pressure   

High blood pressure can induce hypertrophy, which thickens the heart’s wall. To keep up with the rapid circulation, the muscles get tighter. As a result, the muscles fail to relax, putting one at risk of heart failure.

If the heart has to work harder against blood flow since to a decreased ejection fraction, it can result in heart failure.

Aortic valve stenosis   

Acute aortic insufficiency occurs when the heart’s aortic valve closes partially or fully. When this happens, blood can’t get through to the body properly, and it cannot efficiently pump itself. The muscle that pumps blood becomes weakened as a consequence of decreased pumping strength; however, not enough blood is lost in this condition to cause significant damage.

Hypertrophic cardiomyopathy (HCM)   

Here the muscles thicken up more than usual, and they have to struggle much harder to pump the average amount of blood. The walls can also grow hard, causing heart failure in a short amount of time.

Mitral valve regurgitation   

In this condition, the heart’s mitral valve closes or narrows down, which causes the blood to flow backward. A decrease in the diameter of the mitral valve can lead to this difficulty, which causes a decreased ejection fraction and eventually heart failure.

Myocarditis   

This can cause arrhythmia as well as heart failure. This is mainly inflammation of the muscles, which can reduce the heart’s ability to circulate blood.   

Arrhythmia   

This means irregular heartbeat or where the heart doesn’t follow a regular pattern. Abnormality of the heartbeat can cause pumping ineffectiveness.    

Pericardial disease   

Pericarditis happens in the pericardial layer of the heart and causes infection. The pericardial fluid surrounds and thickens the place, limiting the heart’s ability to fill.   

Treatment for irregular ejection fraction   

There are several options available in this sector and are done on different conditions of heart diseases, such as the ventricular assist devices.    

Beta-blockers   

These are used to reduce high blood pressure. They are also known as the beta-adrenergic blocking medication that manages abnormality of the heart and is often used to prevent further loss.    

Water pills   

These are used to promote diuresis, which means getting rid of the water and salt from the blood. This helps produce more urine and diminishes the flow of blood in arteries, reducing blood pressure.    

Eplerenone   

Eplerenone is used to treat hypertension and works against aldosterone. This treats abnormal ejection fraction and heart failure.    

ICD   

This is the implantable cardioverter-defibrillator that helps to regulate heartbeat and is used as a treatment of arrhythmia.    

Hydralazine   

Hydralazine is used to treat hypertension and heartbeat failure. This lowers blood pressure and chances of heart attack and kidney problems, relaxing the arteries and veins.   

Aspirin and clopidogrel   

These medicines have been around for a long time now, and they help keep your blood vessels open and have an anti-clotting effect. The clopidogrel is often called super aspirin and is used with aspirins in general.    

Pacemaker   

The Pacemaker is an implanted device that helps to control the heartbeat. This machine generates electrical pulses, which allow the heart to contract the proper amount of blood. The pacemaker is typically surgically implanted in the chest.   

Cardiac resynchronization therapy

This is done by connecting two electrodes on the left and right ventricle of the heart to prevent heart failure.

How to improve your ejection fraction?    

There are some ways where you can improve your ejection fraction and avoid the possibility of heart failure.   

How to improve your ejection fraction?

Talk to a doctor  

If you are experiencing any pain or tiredness in your chest, consult a doctor. They will examine your heart and possibly diagnose what is causing your complications. 

Proper treatment   

If you are diagnosed with any abnormality in ejection fraction, first ask what level of the diagnosis you are in. The consultant will proceed as such. It can be just hypertension rather than severe heart failure.   

Workout   

Even when you don’t have any heart condition, you should exercise at least thrice a week. This will strengthen your cardiac muscles, and blood flow will be proper.    

Obesity can also cause heart disease; you can have a good outcome with proper activity and diet. But if you are diagnosed with some cardiac disease of abnormal ejection fraction, then take recommendations from your physicians regarding this. You can even join the cardiac rehabs to get a decent idea.   

Limit the sodium intake   

Patients with the chance of heart failure are asked to limit their sodium intake. Sodium tends to increase fluid in your system, and this makes the heart work harder. And with restricting the input to fifteen hundred milligrams per day, you’ll be able to maintain good health.    

Lower your substance abuse   

Alcohol, cigarettes, and other drugs always raise the risks of heart disease rate. And they can even worsen the symptoms if not used properly. Any use of drugs like cocaine will only deteriorate your ejection fraction percentage.    

To sum up…   

It can be challenging to live with a chronic disease like heart failure, but you can typically minimize the chance of the condition progressing to a severe level. Take care of your body and ensure that abnormal ejection fraction doesn’t cause a more severe heart condition.

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