Norms of the ejection fraction of the left ventricle of the heart, causes of low and elevated rates, methods of treatment and prognosis. Decreased and increased ejection fraction of the heart Mean fv

When the patient receives the test results, he tries to independently figure out what each value received means, how critical the deviation from the norm is. An important diagnostic value is the indicator of cardiac output, the norm of which indicates a sufficient amount of blood ejected into the aorta, and the deviation indicates approaching heart failure.

Estimation of the ejection fraction of the heart

When a patient contacts the clinic with complaints of pain in, the doctor will prescribe a complete diagnosis. A patient who encounters this problem for the first time may not understand what all the terms mean, when certain parameters increase or decrease, how they are calculated.

The ejection fraction of the heart is determined with the following patient complaints:

heartache;
tachycardia;
dyspnea;
dizziness and fainting;
increased fatigue;
pain in the chest area;
interruptions in the work of the heart;
limb edema.

Indicative for the doctor will be a biochemical blood test and an electrocardiogram. If the data obtained is not enough, ultrasound, Holter monitoring of the electrocardiogram, and bicycle ergometry are performed.

The ejection fraction index is determined in the following studies of the heart:

isotope ventriculography;
radiopaque ventriculography.

The ejection fraction is not a difficult indicator to analyze; even the simplest ultrasound machine shows the data. As a result, the doctor receives data showing how efficient the heart is at each beat. During each contraction, a certain percentage of blood is ejected from the ventricle into the vessels. This volume is referred to as the ejection fraction. If out of 100 ml of blood in the ventricle, 60 cm 3 were received, then the cardiac output was 60%.

The work of the left ventricle is considered indicative, since blood enters the systemic circulation from the left side of the heart muscle. If failures in the work of the left ventricle are not detected in time, then there is a risk of getting heart failure. A low cardiac output indicates the impossibility of the heart to contract at full strength, therefore, the body is not provided with the necessary volume of blood. In this case, the heart is supported medically.

How is the ejection fraction calculated?

To calculate, the following formula is used: stroke volume times heart rate. The result will show how much blood is pushed out by the heart in 1 minute. The average volume is 5.5 liters.
Formulas for calculating cardiac output have names.

Teicholz formula. The calculation is performed automatically by the program, into which data on the final systolic and diastolic volume of the left ventricle are entered. The size of the organ also matters.
Simpson formula. The main difference lies in the possibility of getting into the cut of the circle of all sections. The study is more revealing, it requires modern equipment.

The data obtained by two different formulas may differ by 10%. The data are indicative for the diagnosis of any disease of the cardiovascular system.

Important nuances in measuring the percentage of cardiac output:

the result is not affected by the gender of the person;
the older the person, the lower the rate;
a pathological condition is considered an indicator below 45%;
a decrease in the indicator of less than 35% leads to irreversible consequences;
a reduced rate may be an individual feature (but not lower than 45%);
the indicator increases with hypertension;
in the first few years of life, in children, the ejection rate exceeds the norm (60-80%).

Normal EF

Normally, more blood passes through, regardless of whether the heart is currently loaded or at rest. Determining the percentage of cardiac output allows timely diagnosis of heart failure.

Normal values of the ejection fraction of the heart

The rate of cardiac output is 55-70%, 40-55% is read as a reduced rate. If the indicator drops below 40%, heart failure is diagnosed, an indicator below 35% indicates possible irreversible life-threatening heart failures in the near future.

Exceeding the norm is rare, since physically the heart is not able to expel more blood into the aorta than it should be. The indicator reaches 80% in trained people, in particular, athletes, people leading a healthy, active lifestyle.

An increase in cardiac output may indicate myocardial hypertrophy. At this point, the left ventricle tries to compensate for the initial stage of heart failure and pushes the blood out with more force.

Even if the body is not affected by external irritating factors, it is guaranteed that 50% of the blood will be pushed out with each contraction. If a person is worried about his health, then after the age of 40, it is recommended to undergo an annual medical examination by a cardiologist.

The correctness of the prescribed therapy also depends on the definition of the individual threshold. An insufficient amount of processed blood causes a deficiency in the supply of oxygen in all organs, including.

Causes of a reduced ejection fraction of the heart

The following pathologies lead to a decrease in the level of cardiac output:

cardiac ischemia;
myocardial infarction;
heart rhythm disturbances (arrhythmia, tachycardia);
cardiomyopathy.

Each pathology of the heart muscle in its own way affects the work of the ventricle. During coronary heart disease, blood flow decreases, after a heart attack, the muscles become covered with scars that cannot contract. Violation of the rhythm leads to a deterioration in conductivity, rapid wear of the heart, and leads to an increase in muscle size.

In the early stages of any disease, ejection fraction does not change much. The heart muscle adapts to new conditions, the muscle layer grows, small blood vessels are rebuilt. Gradually, the possibilities of the heart are exhausted, muscle fibers are weakened, the volume of absorbed blood decreases.

Other diseases that reduce cardiac output:

angina;
hypertension;
aneurysm of the wall of the ventricle;
infectious and inflammatory diseases (pericarditis, myocarditis,);
myocardial dystrophy;
cardiomyopathy;
congenital pathologies, violation of the structure of the body;
vasculitis;
vascular pathology;
hormonal disruptions in the body;
diabetes;
obesity;
tumors of the glands;
intoxication.

Symptoms of reduced ejection fraction

A low ejection fraction indicates serious cardiac pathologies. Having received the diagnosis, the patient needs to reconsider the way of life, to exclude excessive stress on the heart. Deterioration of the condition can cause emotional disorders.

The patient complains of the following symptoms:

increased fatigue, weakness;
the occurrence of a feeling of suffocation;
respiratory disorders;
hard to breathe in the supine position;
visual disturbances;
loss of consciousness;
heartache;
increased heart rate;
swelling of the lower extremities.

In more advanced stages and with the development of secondary diseases, the following symptoms occur:

decreased sensitivity of the limbs;
liver enlargement;
lack of coordination;
weight loss
nausea, vomiting, blood in;
abdominal pain;
accumulation of fluid in the lungs and abdomen.

Even if there are no symptoms, this does not mean that a person does not suffer from heart failure. Conversely, the pronounced symptoms listed above will not always result in a reduced percentage of cardiac output.

Ultrasound - norms and interpretation

Ultrasound examination of the heart

Ultrasound examination provides several indicators by which the doctor judges the state of the heart muscle, in particular, the functioning of the left ventricle.

Cardiac output, the norm is 55-60%;
The size of the atrium of the right chamber, the norm is 2.7-4.5 cm;
Aortic diameter, normal 2.1-4.1 cm;
The size of the atrium of the left chamber, the norm is 1.9-4 cm;
Stroke volume, normal 60-100 cm.

It is important to evaluate not each indicator separately, but the overall clinical picture. If there was a deviation from the norm up or down in only one indicator, additional research will be required to determine the cause.

When is treatment for reduced ejection fraction required?

Immediately after receiving the ultrasound results and determining the reduced percentage of cardiac output, the doctor will not be able to determine the treatment plan and prescribe medications. It is necessary to deal with the cause of the pathology, and not with the symptoms of a reduced ejection fraction.

Therapy is selected after a complete diagnosis, definition of the disease and its stage. In some cases, this is drug therapy, sometimes surgery.

How to increase the reduced ejection fraction?

First of all, medications are prescribed to eliminate the root cause of the reduced ejection fraction. A mandatory point of treatment is taking drugs that increase myocardial contractility (cardiac glycosides). The doctor selects the dosage and duration of treatment based on the results of the tests, uncontrolled intake can lead to glycosidic.

Heart failure is not only treated with pills. The patient must control the drinking regime, the daily volume of fluid drunk should not exceed 2 liters. Salt must be removed from the diet. Additionally, diuretics, beta-blockers, ACE inhibitors, Digoxin are prescribed. Medicines that reduce the heart's need for oxygen will help alleviate the condition.

Modern surgical methods restore blood flow in coronary disease and eliminate severe heart defects. From arrhythmia, an artificial heart driver can be installed. The operation is not performed when the percentage of cardiac output falls below 20%.

Prevention

Preventive measures are aimed at improving the state of the cardiovascular system.

Active lifestyle.
Lessons .
Proper nutrition.
Rejection of bad habits.
Outdoor recreation.
Getting rid of stress.

What is the ejection fraction of the heart:

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During an ultrasound examination of the heart, the state of the cardiovascular system is assessed not only by the size of the organ and its departments, but also by the parameters of cardiac hemodynamics. One such indicator is the ejection fraction. About what it is and what is the norm of the ejection fraction of the heart, read on.

What is the ejection fraction of the heart

The efficiency of the heart is determined by the volume of blood that it throws into the main vessels at the time of contraction of the ventricles. The more blood enters the aorta, and from it to the arteries, blood-supplying organs and tissues, the more oxygen and nutrients enter the cells of the body. It is important to understand that at the time of systole, not all the blood in the cavity of the organ enters the vessels. The volume of blood remaining in the ventricles after contraction is called the end-diastolic volume (EDV).

Cardiac output (SW) is the amount of blood ejected by the heart per unit of time in ml. In clinical practice, CO is calculated in ml/min, i.e. This is the number of ml of blood ejected into the main vessels in 1 minute.

Cardiologists also distinguish the concept of stroke volume (SV) - the number of ml of blood ejected by the body in one contraction. Knowing the SV, you can easily calculate the approximate value of cardiac output: for this, you need to multiply the stroke volume by the number of heartbeats per minute.

How is the rate of cardiac output calculated on ultrasound

When performing an ultrasonographic study of cardiac activity, the ejection fraction (EF) of the left ventricle is calculated - this is the percentage ratio of the volume of blood entering the aorta to the amount of blood remaining in the left ventricle, expressed as a percentage.

In other words, it is the ratio of stroke volume to EDV. For example, if at the time of diastole (myocardial relaxation) there was 100 ml of blood in the heart, and 75 ml of blood was expelled during systole (contraction), then the EF will be 75%. The ultrasound scanner calculates this indicator automatically, then it is entered into the study protocol.

What determines the value of the ejection fraction

Knowing the EF index, the cardiologist can evaluate the contractile function of the heart muscle. The more blood is expelled by the heart at the time of contraction, the more efficiently the myocardium works and vice versa. Ejection fraction is one of the markers of heart failure. By the value of this parameter and its change during dynamic observation, you can:

identify latent (asymptomatic) cardiac pathologies;
monitor the progression of myocardial insufficiency;
evaluate the effectiveness of drug therapy;
predict the course of the disease.

The normal value of the ejection fraction of the heart on ultrasound

On ultrasound of the heart, the ejection fraction norm is at least 45% and not more than 75%. On average, in a healthy person, this figure at rest is 50%. When evaluating the value of EF, the doctor looks at what formula was used to calculate, since the lower value of the indicator changes depending on this.

In newborns and infants, the cardiac output fraction is normally 60-80%. As the child grows, the values of the indicator gradually decrease.

During exercise, the value of EF increases to a maximum of 80-85%. This is determined by performing echocardiography with exercise. An increase in the value of the ejection fraction with an increase in the body's need for oxygen makes it possible to assess the functional reserves of the myocardium. This is an important diagnostic criterion in the examination of professional athletes and the military.

Features of the indicator

The norm of EF of the heart is the same for men and women. In older people, there is a decrease in ejection fraction due to age-related changes in the heart muscle.
The level of the indicator in the range of 45–50% can be a variant of the norm and an individual feature. A drop below 45% is always a sign of pathology.
An increase in the numerical indicators of the cardiac ejection fraction is observed with an increase in the number of heartbeats.
A drop in EF below 35% is an indicator of irreversible changes in the heart muscle.

Causes and symptoms of a decrease in the value of the indicator

Detection of cardiac output in echocardiography of less than 45–50% is a sign of a decrease in myocardial contractility. This occurs with the following diseases:

Symptoms that indicate a decrease in ejection fraction are associated with the development of heart failure in a person. The main ones are:

increase in shortness of breath. At first it appears only during physical exertion, but then it also occurs at rest;
decreased resistance to physical stress;
pain syndrome in the region of the heart, behind the sternum;
cardiac edema. With an increase in heart failure, the initially appeared pastosity of the legs in the second half of the day passes the general edema of the whole body;
cardiac arrhythmias. As a rule, tachycardia develops. Thus, the heart tries to compensate for the fall in cardiac output.

Useful video

What is the ejection fraction of the heart can be found in this video.

Is it possible to treat low ejection fraction?

It is important to understand that low cardiac output fraction is not an independent disease. This is just a manifestation of pathological processes occurring in the cardiovascular system. Therefore, having discovered this symptom, the cardiologist must find out the cause of its occurrence.

The therapy prescribed by the doctor will be aimed at treating the underlying disease.

Monitoring the value of the ejection fraction serves as a way to determine the prognosis of the course of the disease. A fall in EF below 35% is considered a poor prognostic sign.

Prevention of a decrease in cardiac output fraction is aimed at creating optimal conditions for maintaining the health of the cardiovascular system. The main ones are: proper nutrition, weight loss, smoking cessation, daily routine and regular physical activity.

What is the ejection fraction of the heart?

FVS is called an indicator that is calculated using a special formula. The stroke volume of blood that enters the aorta after one contraction of the heart muscle is taken and its ratio is determined in accordance with the end-diastolic volume of the ventricle - the blood accumulated in the cavity during the relaxation period.

The resulting value is multiplied by one hundred percent, which makes it possible to obtain the final result. It is the percentage of blood that is pushed into the ventricle during systole according to the total volume of fluid it contains.

The calculation of the indicator is carried out by computer technology during ultrasonographic examination of the heart chambers. With this diagnostic method, only the left ventricle is examined.

Ultrasonography makes it possible to determine the ability of the left ventricle to perform its functions, which are to ensure adequate blood flow in the body.

Video about what is the ejection fraction of the heart.

Values: norm, deviations

If a person is at physiological rest, then the normal value of EF is a percentage. Significant physical activity in adults leads to an increase in the additional percentage. No further growth is observed. This is due to the fact that the myocardium cannot eject all the blood from the ventricle, as this causes cardiac arrest.

Values: norm, deviations

In modern medicine, only a reduced indicator is evaluated. This is the main criterion that allows you to determine the irrational work of the body. With a decrease in the indicator, most patients are diagnosed with contractile myocardial insufficiency. In this case, the value of the fraction is less than 45 percent.

With contractile insufficiency, there are risks not only for health, but also for human life. With insufficient blood flow to the organs, a violation of their work is observed. Against this background, multiple organ dysfunction develops, which leads to death.

Reduced ejection volume is most often observed against the background of systolic insufficiency. It is completely impossible to get rid of this pathological condition. If certain conditions arise, then the treatment is carried out by an endovascular or vascular surgeon. Gender has no effect on EF. In elderly patients, there is a physiological decrease in performance.

With a decrease in EF, we can talk about an individual norm. But, with a value of less than 45 percent, a pathological process is diagnosed. In a healthy person, the EF value may increase if the heart rate and blood pressure increase. If radionuclide angiography is used to measure the indicator, then the norm is a percentage.

If a patient is diagnosed with an indicator of less than 35 percent, then this indicates the occurrence of irreversible processes in the myocardium. In the first few years of a child's life, the EF norms are higher and make up a percentage.

The ejection fraction of the heart is a necessary indicator by which the prognosis of various cardiovascular diseases is determined.

Causes of heart failure

A decrease in EF is diagnosed against the background of various diseases. In most cases, pathology is diagnosed if chronic heart failure develops. This disease appears when:

Ischemic disease. With this disease, blood flow to the coronary arteries, which provide oxygen to the heart muscle, is reduced.
Myocardial infarctions. In most cases, the pathology develops after transmural and macrofocal infarcts. After this critical condition, the muscle cells of the organ are replaced by scar tissue. It cannot contract, which leads to the formation of postinfarction cardiosclerosis.
Conduction and rhythm disorders, which are often observed and are characterized by an acute course. Against this background, the muscle gradually wears out. Her contractions are irrational and non-rhythmic. In most cases, pathology is diagnosed when a variety of pathological processes occur, which lead to disruption of the organ.
Cardiomyopathy. With this disease, the appearance of structural disorders is observed in the configuration of the heart. They occur when the muscle of the organ is stretched or hypertrophied. The cause of this pathology can be a violation of the hormonal background, prolonged arterial hypertension, in which there are high blood pressure, organ defects, etc.

A decrease in cardiac EF can be diagnosed against the background of various cardiac diseases. That is why they are recommended to be treated in a timely manner.

Diagnostics

Values: norm, deviations

The pathological process is characterized by the presence of relevant signs. Thanks to the symptoms of the disease, doctors are able to correctly and timely diagnose.

Patients complain of pain in the right side of the abdomen. It can also increase in size, due to fluid retention in the abdominal cavity.

This condition is observed with venous stasis. If it is observed for a long period, then the patient may develop cardiac cirrhosis of the liver.

Patients may experience shortness of breath not only during physical overload, but also during the rest period. Patients report that shortness of breath appears in the supine position, especially at night. In pathology, the development of swelling of the skin on the face, feet and legs is diagnosed.

Untimely treatment of pathology leads to swelling of the internal organs, which is explained by a violation of blood circulation in the vessels of the subcutaneous fat, which leads to fluid stagnation in it.

A decrease in the ejection fraction of the heart is the cause of frequent weakness and excessive fatigue, even when doing the usual things. In some patients with pathology, the frequent occurrence of dizziness was diagnosed. In some cases, loss of consciousness was diagnosed. This is due to insufficient blood supply to the brain and skeletal muscles.

The disease can be accompanied by a disorder of the stool, as well as nausea and vomiting. Some people complain about the appearance of blood in the stool. Periodically, there may be impaired sensitivity in the limbs. With a long course of pathology, a rapid decrease in body weight is observed. Patients talk about the appearance of pain in the region of the heart, which is characterized by varying degrees of intensity.

The indicator is determined using an electrocardiogram. Patients are also given an ultrasound scan. Thanks to these examinations, the degree of cardiac output is determined. Diagnostics does not require specific training and is highly informative.

Diagnosis of cardiac EF provides an opportunity to determine the severity of the pathology and develop the correct tactics of therapy.

Treatment

Ejection fraction of the heart: treatment

Pathology therapy is carried out if the EF is less than 45 percent. This condition indicates that the functionality of the heart muscle is reduced against the background of various diseases.

Therapy is aimed at stabilizing pathological changes in the early stages. In most cases, drug therapy is carried out using:

Angiotensin converting enzyme inhibitors. With the help of this medicine, the nutrition of the heart tissues improves, and the peripheral arteries also expand. With regular use of drugs, the performance of the heart muscles significantly increases, and the resistance of the myocardium to stress increases. Patients are recommended to take Ramipril, Enalapril, Captopril
Beta blockers. Thanks to these drugs, the body's need for oxygen and other nutrients is reduced. When using the drug, the heart rate decreases, the processes of natural cell death decrease. It is recommended to take Metoporolol, Nebivol, Bisoprolol
Aldosterone receptor antagonists. The action of drugs is aimed at stabilizing the amount of electrolytes. During the period of treatment, excess fluid is removed and the load on the organ is reduced. Patients are prescribed Eplerenone, Spironolactone
Diuretics or diuretics. The drugs remove excess fluid from the body and reduce the volumetric load on the body. Recommended use of Indapamide, Torasemide, Hypothiazid
cardiac glycosides. The drug improves the contractility of the heart muscles, increase conductivity in violation of myocardial functions. Treatment of patients is carried out using Strofantin, Digoxin
Peripheral vasodilators. Medicines are prescribed in order to reduce the load on the organ and improve blood flow in the region of the heart vessels. Patients are advised to take Nitroglycerin, Apressin, Sodium nitroprusside
Calcium channel blockers. Thanks to medicines, the vessels of the heart expand, and the quality of tissue nutrition also increases. Therapy is carried out with Nifedipine, Nimodipine, Verapamil
Disaggregants. Preparations are recommended to be used in order to eliminate the possibility of the formation of clots. For the treatment of pathology, it is recommended to take Aspirin, Plavix
Antirhythmic agents. Medications stop violations in the rhythm of myocardial contractions. Therapy is carried out with Diltiazem, Disopyramide, Amiodarone

In particularly severe cases, surgical intervention is recommended. Patients are placed on pacemakers or pacemakers if there are life-threatening abnormalities in the heart rhythm. In some cases, resynchronization therapy is used. With its help, contractions of the ventricles and atria are stimulated in various rhythms.

During the treatment of pathology, it is necessary to adhere to certain recommendations. The patient needs to provide normal nutrition that will fully satisfy the needs of his body. Also, the patient must strictly observe the regimen of the day and rest.

Treatment of reduced EF of the heart can be the use of a variety of techniques. The choice of a specific therapeutic method is carried out only by a qualified specialist in accordance with the individual characteristics of the patient and the severity of the pathology.

Prevention

If the patient does not have a genetic predisposition, then he can fully regulate the norm of the fraction. In this case, he is recommended to follow certain rules of prevention. A person must exercise every day. It is also recommended to consume foods that contain a large amount of iron.

In order to prevent pathology, it is necessary to stop smoking. A person should minimize the use of alcoholic beverages. An excellent preventive method is to maintain a healthy lifestyle.

If possible, then a person should go to aerobics several times a week. Dietary nutrition will eliminate the threat of the development of pathology. It is best to give preference to dishes that contain a minimum amount of salt. With a hereditary predisposition to the disease, it is recommended to refuse to visit gyms.

EF of the heart is a severe pathological process that can cause death. The pathological process can develop in a variety of cardiac diseases. It is accompanied by certain symptoms, the appearance of which requires a diagnosis, which will allow you to prescribe the optimal treatment regimen. In order to avoid pathology, its prevention should be carried out in a timely manner.

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The normal value of the ejection fraction of the heart, deviations of the indicator

From this article, you will learn about the ejection fraction of the heart: the rate of the indicator, how it is calculated and what it shows. When the deviation of the ejection fraction (abbreviated as EF) is dangerous, why does a pathological change appear. Symptoms of the indicator going beyond the normal limits, principles of treatment and prognosis.

Ejection fraction (EF) is the ratio of stroke volume (blood that enters the aorta in one contraction of the heart muscle) to the end-diastolic volume of the ventricle (blood that accumulates in the cavity during the period of relaxation, or diastole, of the myocardium). The resulting value is multiplied by 100% and the final value is obtained. That is, this is the percentage of blood that pushes the ventricle during systole, of the total volume of fluid contained in it.

The indicator is calculated by the computer during the ultrasonographic examination of the heart chambers (echocardiography or ultrasound). It is used only for the left ventricle and directly reflects its ability to perform its function, that is, to provide adequate blood flow throughout the body.

Under conditions of physiological rest, the normal value of EF is considered to be 50–75%; during physical exertion in healthy people, it increases to 80–85%. There is no further increase, since the myocardium cannot eject all the blood from the ventricular cavity, which will lead to cardiac arrest.

In medical terms, only a decrease in the indicator is evaluated - this is one of the main criteria for the development of a decrease in the working capacity of the heart, a sign of contractile myocardial insufficiency. This is evidenced by the value of EF below 45%.

Such insufficiency poses a great danger to life - a small flow of blood to the organs disrupts their work, which ends in multiple organ dysfunction and ultimately leads to the death of the patient.

Given that the cause of the decrease in the volume of left ventricular ejection is its systolic insufficiency (as the outcome of many chronic pathologies of the heart and blood vessels), it is impossible to completely cure this condition. Treatment is carried out that supports the myocardium and is aimed at stabilizing the condition at the same level.

Cardiologists and internists are involved in the monitoring and selection of therapy for patients with low ejection fraction. Under certain conditions, the assistance of a vascular or endovascular surgeon may be required.

Features of the indicator

The ejection fraction does not depend on the gender of the person.
With age, a physiological decrease in the index is noted.
A low EF may be an individual norm, but a value of less than 45% is always considered pathological.
All healthy people have an increase in the value with an increase in heart rate and blood pressure.
The norm of the indicator when measuring by radionuclide angiography is 45–65%.
Simpson or Teicholtz formulas are used for measurement, normal values, depending on the method used, fluctuate up to 10%.
The critical level of reduction of 35% or less is a sign of irreversible changes in myocardial tissues.
For children in the first years of life, higher norms of 60–80% are characteristic.
The indicator is used to determine the prognosis of any cardiovascular disease in patients.

Reasons for the decline

At the initial stages of any disease, the ejection fraction remains normal due to the development of adaptation processes in the myocardium (thickening of the muscle layer, increased work, restructuring of small blood vessels). As the disease progresses, the possibilities of the heart exhaust themselves, there is a violation of the contractility of muscle fibers, and the volume of ejected blood decreases.

All influences and diseases that have a negative effect on the myocardium lead to such violations.

Acute myocardial infarction

Cicatricial changes in the heart tissue (cardiosclerosis)

Painless form of ischemia

Tachy and bradyarrhythmias

Aneurysm of the ventricular wall

Endocarditis (changes on the inner lining)

Pericarditis (disease of the heart bag)

Congenital disorders of the normal structure or defects (violation of the correct location, a significant decrease in the lumen of the aorta, pathological connection between large vessels)

Aneurysm of any part of the aorta

Aortoarteritis (damage by cells of one's own immunity to the walls of the aorta and its branches)

Thromboembolism of the lungs

Diabetes mellitus and impaired glucose uptake

Hormonally active tumors of the adrenal glands, pancreas (pheochromocytoma, carcinoid)

Stimulant drugs

Symptoms of a decrease in the indicator

Low ejection fraction is one of the main criteria for cardiac dysfunction, so patients are forced to significantly limit their labor and physical activity. Often, even simple chores around the house cause a deterioration in the condition, which forces most of the time to sit or lie in bed.

Manifestations of a decrease in the indicator are distributed according to the frequency of occurrence from the most frequent to the rarest:

significant loss of strength and fatigue from the usual loads;
respiratory failure by the type of increase in frequency, up to attacks of suffocation;
breathing problems worse when lying down;
collaptoid states and loss of consciousness;
vision changes (darkening in the eyes, "flies");
pain syndrome in the projection of the heart of varying intensity;
increase in the number of heart contractions;
swelling of the legs and feet;
accumulation of fluid in the chest and abdomen;
a gradual increase in the size of the liver;
progressive weight loss;
episodes of impaired coordination and gait;
periodic decrease in sensitivity and active mobility in the limbs;
discomfort, moderate pain in the projection of the abdomen;
unstable chair;
bouts of nausea;
vomiting with an admixture of blood;
blood in stool.

Treatment with a decrease in the rate

An ejection fraction of less than 45% is a consequence of a change in the functionality of the heart muscle against the background of the progression of the underlying disease-cause. A decrease in the indicator is a sign of irreversible changes in the tissues of the myocardium, and there is no longer any talk of the possibility of a complete cure. All therapeutic measures are aimed at stabilizing pathological changes at their early stage and improving the patient's quality of life at a later stage.

The complex of treatment includes:

correction of the main pathological process;
therapy for left ventricular failure.

This article is devoted directly to left ventricular EF and the types of its violation, therefore, further we will only talk about this part of the treatment.

Drug correction

Basic drugs

Improving the nutrition of the heart tissue

Increasing myocardial resistance to stress

A significant increase in the performance of the heart muscle

Decreased heart rate

Reducing the processes of natural death of heart cells in conditions of increased work

Increase in the number of zones with active contraction in the myocardium

Removing excess fluid and reducing the load on the myocardium

Reducing the volume load on the myocardium

Increased conduction in conditions of impaired myocardial function

Additional funds

Vascular protection in conditions of altered blood flow

Prevention of clot formation against the background of venous stasis

Auxiliary drugs

Improving blood flow in the heart vessels

Surgical correction

Installation of pacemakers or cardiovector-defibrillators for life-threatening cardiac arrhythmias.
Resynchronization therapy - stimulation of the contraction of the ventricles and atria in different rhythms (slowing down the contraction of the ventricles by creating an artificial heart block).

Non-drug correction

Normalization of nutrition in accordance with the needs of the body to stabilize normal weight.
Dosed, but mandatory physical activity.
Normalization of work-rest.
Psychotherapeutic help.
Physio- and reflexology.

Forecast

If the left ventricular ejection fraction decreases, being in the range of 40-45%, the risk of death due to cardiac arrest is about 10-15%.
A decrease to 35-40% raises this risk to 20-25%.
A further decrease in the index exponentially worsens the prognosis for patient survival.

There is no complete cure for the pathology, but timely therapy can prolong life and maintain its relatively satisfactory quality.

Cardiac output: the norm and causes of deviation

What is ejection fraction and why should it be estimated?

Estimation of the ejection fraction of the heart

When a patient contacts the clinic with complaints of pain in the heart, the doctor will prescribe a complete diagnosis. A patient who encounters this problem for the first time may not understand what all the terms mean, when certain parameters increase or decrease, how they are calculated.

The ejection fraction of the heart is determined with the following patient complaints:

heartache;
tachycardia;
dyspnea;
dizziness and fainting;
increased fatigue;
pain in the chest area;
interruptions in the work of the heart;
limb edema.

Indicative for the doctor will be a biochemical blood test and an electrocardiogram. If the data obtained is not enough, ultrasound, Holter monitoring of the electrocardiogram, and bicycle ergometry are performed.

The ejection fraction index is determined in the following studies of the heart:

isotope ventriculography;
radiopaque ventriculography.

How is the ejection fraction calculated?

To calculate, the following formula is used: stroke volume times heart rate. The result will show how much blood is pushed out by the heart in 1 minute. The average volume is 5.5 liters.

Formulas for calculating cardiac output have names.

Teicholz formula. The calculation is performed automatically by the program, into which data on the final systolic and diastolic volume of the left ventricle are entered. The size of the organ also matters.
Simpson formula. The main difference lies in the possibility of getting into the slice of the circumference of all sections of the myocardium. The study is more revealing, it requires modern equipment.

The data obtained by two different formulas may differ by 10%. The data are indicative for the diagnosis of any disease of the cardiovascular system.

Important nuances in measuring the percentage of cardiac output:

the result is not affected by the gender of the person;
the older the person, the lower the rate;
a pathological condition is considered an indicator below 45%;
a decrease in the indicator of less than 35% leads to irreversible consequences;
a reduced rate may be an individual feature (but not lower than 45%);
the indicator increases with hypertension;
in the first few years of life, in children, the ejection rate exceeds the norm (60-80%).

Normal EF

Normally, more blood passes through the left ventricle, regardless of whether the heart is currently loaded or at rest. Determining the percentage of cardiac output allows timely diagnosis of heart failure.

Normal values of the ejection fraction of the heart

The rate of cardiac output is 55-70%, 40-55% is read as a reduced rate. If the indicator drops below 40% - heart failure is diagnosed, an indicator below 35% indicates possible irreversible life-threatening heart failures in the near future.

The correctness of the prescribed therapy also depends on the definition of the individual threshold. An insufficient amount of processed blood causes a shortage of oxygen in all organs, including the brain.

Causes of a reduced ejection fraction of the heart

The following pathologies lead to a decrease in the level of cardiac output:

cardiac ischemia;
myocardial infarction;
heart rhythm disturbances (arrhythmia, tachycardia);
cardiomyopathy.

Other diseases that reduce cardiac output:

angina;
hypertension;
aneurysm of the wall of the ventricle;
infectious and inflammatory diseases (pericarditis, myocarditis, endocarditis);
myocardial dystrophy;
cardiomyopathy;
congenital pathologies, violation of the structure of the body;
vasculitis;
vascular pathology;
hormonal disruptions in the body;
diabetes;
obesity;
tumors of the glands;
intoxication.

Symptoms of reduced ejection fraction

The patient complains of the following symptoms:

increased fatigue, weakness;
the occurrence of a feeling of suffocation;
respiratory disorders;
hard to breathe in the supine position;
visual disturbances;
loss of consciousness;
heartache;
increased heart rate;
swelling of the lower extremities.

In more advanced stages and with the development of secondary diseases, the following symptoms occur:

decreased sensitivity of the limbs;
liver enlargement;
lack of coordination;
weight loss
nausea, vomiting, blood in the stool;
abdominal pain;
accumulation of fluid in the lungs and abdomen.

Even if there are no symptoms, this does not mean that a person does not suffer from heart failure. Conversely, the pronounced symptoms listed above will not always result in a reduced percentage of cardiac output.

Ultrasound - norms and interpretation

Ultrasound examination of the heart

Ultrasound examination provides several indicators by which the doctor judges the state of the heart muscle, in particular, the functioning of the left ventricle.

Cardiac output, the norm is 55-60%;
The size of the atrium of the right chamber, the norm is 2.7-4.5 cm;
Aortic diameter, normal 2.1-4.1 cm;
The size of the atrium of the left chamber, the norm is 1.9-4 cm;
Stroke volume, standard cm.

When is treatment for reduced ejection fraction required?

Therapy is selected after a complete diagnosis, definition of the disease and its stage. In some cases, this is drug therapy, sometimes surgery.

How to increase the reduced ejection fraction?

Prevention

Preventive measures are aimed at improving the state of the cardiovascular system.

Active lifestyle.
Sports.
Proper nutrition.
Rejection of bad habits.
Outdoor recreation.
Getting rid of stress.

What is the ejection fraction of the heart:

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The materials are intended for familiarization and personal education. The site cannot be used to diagnose and treat diseases, be sure to visit your doctor! Support the site | about the project

Today, in the age of technology, the development of cardiovascular diseases causes quite serious concerns not only among employees of medical organizations, but also in the upper levels of government. That is why more and more new strategies are being developed to reduce the diseases in question, scientific research is being actively funded that will allow us to achieve these goals in the future.

One of the directions in the treatment of patients with cardiovascular diseases is the prevention and treatment of cardiac pathology. If in this area some of the diseases can be successfully treated, others still remain "intractable" due to the lack of techniques and other necessary components of proper treatment. This article discusses the concepts of cardiac output, its norms and methods of treatment, the ejection fraction of the heart (the norm in children and adults).

Current position

Due to the increase in life expectancy among the elderly, the prevalence of cardiac pathology, especially with impaired ejection fraction, is increasing in this group. In recent years, proven methods of drug treatment and the use of resynchronizing devices, a cardioverter-defibrillator have been developed that prolong life and improve its quality in patients with this pathology.

However, methods for treating heart pathology with a normal fraction have not been determined, the treatment of this pathology remains empirical. There are also no proven treatments for acute forms of cardiac decompensation (pulmonary edema). Until now, the main drugs in the treatment of this condition are diuretics, oxygen and nitro drugs. The ejection fraction of the heart, its norm, its pathology, require a serious approach to the problem.

It is possible to visualize the heart muscle and determine the work (atria, ventricles) using Doppler cardiography. To understand, examine its ability to contract (systolic function) and relax (diastolic function) of the myocardium.

Fraction values

The ejection fraction of the heart, the norm of which is discussed below, is the main instrumental indicator that characterizes the strength of the heart muscle.

Ejection fraction values obtained with Doppler cardiography:

Normal readings are greater than or equal to 55%.
Slight deviation - 45-54%.
Moderate deviation - 30-44%.
The expressed deviation is less than 30%.

If this indicator is less than 40%, the "power of the heart" is reduced. Normal values are above 50%, "heart strength" is good. Allocate a "gray zone" of 40-50%.

Heart failure is a combination of clinical manifestations, biochemical markers, research data (electrocardiography, dopplerography of the heart, radiography of the lungs), which occur with a decrease in the force of contraction of the heart.

There are symptomatic and asymptomatic, systolic and diastolic heart failure.

Relevance of the problem

In the last 20 years, the incidence of heart failure among Europeans has been declining. But the number of cases in the middle and older groups of the population is increasing due to the increase in life expectancy.

According to European studies (conducting ECHOCG), a decrease in ejection fraction was found in half of patients with symptomatic heart failure and in half of asymptomatic patients.

Patients with heart failure are less able to work, their quality of life and its duration are reduced.

The treatment of these patients is the most expensive for them and for the state. Therefore, the search for ways to prevent the occurrence, early diagnosis and effective treatment of heart disease remains relevant.

Studies conducted in recent decades have proven the effectiveness of a number of groups of drugs to improve prognosis, reduce mortality in patients with low cardiac fraction:

adenosine-converting enzyme inhibitors ("enalapril");
angiotensin II antagonists ("Valsartan");
beta-blockers ("Carvedilol");
aldosterone blockers ("Spironolactone");
diuretics ("torasemide");
"Digoxin".

Causes of heart failure

Heart failure is a syndrome that is formed as a result of a violation of the structure or work of the myocardium. Pathology of conduction or heart rhythm, inflammatory, immune, endocrine, metabolic, genetic, pregnancy can cause heart weakness with or without ejection fraction.

Causes of heart failure:

- (more often after a heart attack);

Hypertension;

Combination of coronary artery disease and hypertension;

Idiopathic cardiopathy;

Atrial fibrillation;

Valve defects (rheumatic, sclerotic).

Heart failure:

Systolic (ejection fraction of the heart - the norm is less than 40%);

Diastolic (ejection fraction 45-50%).

Diagnosis of systolic heart failure

Diagnosis of systolic heart failure involves:

1. ejection fraction of the heart - the norm is less than 40%;

2. stagnation in the circles of blood circulation;

3. changes in the structure of the heart (scars, foci of fibrosis, etc.).

Signs of blood stasis:

Increased fatigue;

Dyspnea (shortness of breath), including orthopnea, nocturnal paroxysmal dyspnea - cardiac asthma;

Hepatomegaly;

Expansion of the jugular veins;

Crepitus in the lungs or pleural effusion;

Murmurs on auscultation of the heart, cardiomegaly.

The combination of several of the above symptoms, the presence of information about heart disease helps to establish heart failure, but the Doppler ultrasound of the heart with the definition of structural changes and assessment of myocardial ejection fraction is decisive. In this case, the ejection fraction of the heart will be decisive, the norm after a heart attack of which will be definitely different.

Diagnostic criteria

Criteria for diagnosing heart failure with a normal fraction:

Ejection fraction of the heart - the norm is 45-50%;

Stagnation in a small circle (shortness of breath, crepitus in the lungs, cardiac asthma);

Impaired relaxation or increased myocardial stiffness.

To exclude heart failure in recent years, biological markers have been determined: atrial natriuretic peptide (acute heart failure - more than 300 pg / ml, with chronic heart failure - more than 125 pg / ml). The level of the peptide will help in determining the prognosis of the disease, choosing the optimal treatment.

Patients with a preserved cardiac fraction are usually older and more often women. They have many comorbidities, including arterial hypertension. In these patients, the level of type B in the blood plasma is lower than in patients with a low fraction, but higher than in healthy people.

Tasks for doctors in treating patients

The goals of treating patients with heart failure when the ejection fraction of the heart is above normal:

Relief of the symptoms of the disease;

Reducing the number of readmissions;

Prevention of premature death.

The first step in the correction of heart failure is non-drug treatment:

Limitation of physical activity;

Restriction of salt intake;

fluid restriction;

Weight loss.

Treatment of patients with reduced EF

Step 1: diuretic (torasemide) + inhibitor (enalapril) or an angiotensin II receptor blocker (valsartan) with a gradual increase in dose to a stable state + beta-blocker (carvedilol).

If symptoms persist, step 2: add an aldosterone antagonist (Veroshpiron) or angiotensin II receptor antagonist.

If symptoms persist, it is possible to add Digoxin, Hydralazine, nitropreparations (Cardiket) to the treatment and / or perform invasive interventions (installation of resynchronizing devices, implantation of a cardioverter-defibrillator, heart transplantation), after having previously performed an ultrasound of the heart. The ejection fraction, the norm of which is described above, in this case is determined by ultrasound.

Modern tactics of treating heart failure with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, aldosterone blockers, diuretics, nitrates, hydralazine, digoxin, omacor, if necessary, the installation of resynchronization devices and cardioverter defibrillators in the last two decades has led to a significant increase in survival patients with terminal forms of this disease. This poses new challenges for doctors and researchers.

The search for methods for replacing scar tissue of the myocardium remains relevant.

Conclusion

Thus, from the presented article, one can see the practical value of the methods undertaken by doctors. The ejection fraction of the heart (norm and pathology) has not yet been fully studied. And although medicine is currently not yet perfect to combat the pathologies under consideration, one must hope and invest a sufficient amount of investment in the development and development of scientific research in this area. After all, the development of the medical industry mainly depends on scientists. Therefore, public authorities should provide support to all scientific medical institutions that are trying to move the issue under consideration.

Cardiology is a very serious branch of medicine. It is difficult for an ordinary person to understand its terms. But, given the prevalence of cardiac pathologies, it still does not hurt to know something about the methods for diagnosing cardiovascular insufficiency. Let's understand the concept of "ejection fraction of the heart." What is its norm and why is it violated?

cardiaccases: ejection fraction

The value, which is called the ejection fraction of the heart (EF), allows you to give an objective assessment of the work of this organ, or rather, answer the question of how well the left ventricle performs its duties. It reflects how much blood it pushes out at the moment of contraction.

Why is it so important to establish the performance of the heart muscles of the left rather than the right ventricle? Because it supplies blood to the systemic circulation. If its “deficiency” occurs here, this is a direct path to heart failure. Thus, in order to find out whether this terrible disease threatens a person, it is advisable to determine what work the heart does with each push. In short, the ejection fraction is the percentage of blood volume that the heart muscle ejects into the vessels with each contraction.

To whomshould i check this indicator?

A referral for such a diagnosis is not issued to all patients who applied to a medical facility. It will be received only by those patients who are concerned about such symptoms:

chest pain;
regular interruptions in the activities of this "shock" body;
frequent pulse;
dyspnea;
dizziness;
short-term loss of consciousness;
swelling of the lower limbs;
fatigue;
decline in performance.

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Thus, checking how much blood the ventricle pushes out is necessary for those who have symptoms that indicate problems in the work of the heart.

WhichWill the test help measure EF?

This indicator is determined during ultrasound of the heart, echocardiography and contrast x-ray. This is an inexpensive and accessible examination, which is highly informative, is not associated with painful sensations and does not require special preparation from the patient.

To make it clear how the ejection fraction is determined, let's look at an example. If there was 100 ml of blood in the ventricle, and it sent 55 ml to the vascular system, then the EF is 55%.

Howblood should be pushed out by the heart?

The human "motor" with each contraction throws into the bloodstream more than 50% of the blood contained in the left ventricle. If this value does not reach 50%, then a diagnosis of "insufficiency" is made. This is very dangerous for the body: with a decrease in volume, ischemia, defect, and myocardium develop.

What should be the ejection fraction of the heart in a healthy person? The norm is in the range from 55 to 70% - so much blood in one contraction should put the heart into the aorta. Only in this way will the internal organs be able to receive a sufficient amount of oxygen.

Already at 40-55% there is reason to say that the EF is below the physiological norm. And if this indicator fell to 35-40%, this is a serious warning that a person has big heart problems. You should urgently consult a cardiologist to prevent heart failure.

Whyreduced emissions?

The key reason why cardiac output begins to lag behind the norm is a disorder in the pumping function of the heart. Very “bad” diseases can lead to such a state: cardiomyopathy, heart disease, ischemia, heart attack. Cardiac (primary) factors that cause a decrease in EF include:

violation of the functioning of the heart valves;
failure of the heart rhythm (which provokes wear and tear of the muscle due to non-rhythmic contractions);
myocardial damage (this is the most common cause);
violation of metabolic processes in the heart muscle;
blockage of the coronary arteries.

Practice shows that the release can fall to such an extent that the tissues will no longer receive the necessary nutrients. This results in cardiogenic shock.

There are additional factors that also negatively affect cardiac output. These include an increase in the lumen of small arteries and blockage of large veins, a decrease in the amount of circulating blood, arterial hypertension, and hormonal imbalance.

Howtreat low cardiac output?

Of course, no doctor will start to increase the ejection fraction only on the basis of low ultrasound values. Before deciding how to increase the ejection fraction of the heart, he will try to determine the cause of the low EF. Treatment of low output is aimed at eliminating the source of such a condition and relieving pain, improving the minute volume and nutrition of the heart muscle, and restoring cardiac tone. Additionally, oxygen therapy is used.

To bring EF closer to normal, Dopamine, Dobutamine, Digoxin, Korglikon, Strofantin are used. These medicines help to increase the contractility of our main muscle. Cardiac glycosides can only be prescribed by a doctor, self-medication is extremely dangerous!

If coronary disease contributed to the decrease in EF, then nitroglycerin preparations are prescribed. At defect surgical treatment is shown. If the heart has become worse to perform its duties due to increased pressure, then the patient will be prescribed antihypertensive drugs. To protect the heart and blood vessels, Enalapril, Enam, Perindopril, Prestarium, Kapoten, Lisinopril, Lozap, Lorista, Valz are used.

But it is not always possible to increase the EF exclusively by medication. To cure the disease that caused such a deviation, the help of cardiac surgeons may be needed. To do this, they carry out prosthetic valves, install stents, do coronary artery bypass surgery or install a pacemaker.