- What can you do about heart failure?
- How the normal heart works
- What is heart failure?
- Heart Failure Signs and Symptoms
- How to Live Longer With Heart Failure
- Can You Get Better After a Diagnosis of Heart Failure?
- Living With Congestive Heart Failure: What to Expect
- Low Ejection Fraction
- What Is Ejection Fraction?
- What Is Low Ejection Fraction?
- Low Ejection Fraction Causes
Heart Failure: Understanding Heart Failure
- What is heart failure?
- How common is heart failure?
- Heart failure and aging
- Women and heart failure
- What are the types of heart failure?
- What is ejection fraction?
- How is EF measured?
- Why it’s important to know your EF
- What do the numbers mean?
- What are the symptoms of heart failure?
- Common signs and symptoms of heart failure
- What causes heart failure?
- Heart Diseases & Disorders
- 1. Talk with your healthcare provider about improving your EF.
- 2. Treat any known causes of heart failure.
- 3. Get the right amount of physical activity.
- 4. Pay attention to your weight.
- 5. Know your sodium limits and regulate fluids.
- 6. Eliminate harmful substances.
- 7. Lower your stress.
- What results can I expect?
What can you do about heart failure?
Heart failure caused by damage to the heart that has developed over time can’t be cured. But it can be treated, quite often with strategies to improve symptoms.
Successful treatment depends on your willingness to get involved in managing the condition. You, your loved ones and your caregivers all play an active role as part of the healthcare team.
View an animation of heart failure.
Your treatment plan may include:
- Lifestyle changes
- Devices and surgical procedures
- Ongoing care
- Physical changes to report
- Your healthcare team
- Help for caregivers
Regardless of your treatment approach, you should follow all of your doctor’s recommendations and make the necessary changes in diet, exercise and lifestyle to give you the highest possible quality of life.
Clinical trials are scientific studies that determine if a possible new medical advance can help people and whether it has harmful side effects.
Find answers to common questions about clinical trials in our Guide to Understanding Clinical Trials.
Heart failure is a serious condition, and usually there’s no cure. But many people with heart failure lead a full, enjoyable life when the condition is managed with heart failure medications and healthy lifestyle changes. It’s also helpful to have the support of family and friends who understand your condition.
How the normal heart works
The normal healthy heart is a strong, muscular pump a little larger than a fist. It pumps blood continuously through the circulatory system.
Watch an animation of blood flow through the heart.
The heart has four chambers, two on the right and two on the left:
- Two upper chambers called atria (one is called an atrium)
- Two lower chambers called ventricles
The right atrium takes in oxygen-depleted blood from the rest of the body and sends it back out to the lungs through the right ventricle where the blood becomes oxygenated.
Oxygen-rich blood travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body.
The heart pumps blood to the lungs and to all the body’s tissues through a sequence of highly organized contractions of the four chambers. For the heart to function properly, the four chambers must beat in an organized way.
What is heart failure?
Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen. Basically, the heart can’t keep up with its workload.
Watch an animation of heart failure.
At first the heart tries to make up for this by:
- Enlarging. The heart stretches to contract more strongly and keep up with the demand to pump more blood. Over time this causes the heart to become enlarged.
- Developing more muscle mass. The increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly, at least initially.
- Pumping faster. This helps increase the heart’s output.
The body also tries to compensate in other ways:
- The blood vessels narrow to keep blood pressure up, trying to make up for the heart’s loss of power.
- The body diverts blood away from less important tissues and organs (like the kidneys), the heart and brain.
These temporary measures mask the problem of heart failure, but they don’t solve it. Heart failure continues and worsens until these compensating processes no longer work.
Eventually the heart and body just can’t keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.
The body’s compensation mechanisms help explain why some people may not become aware of their condition until years after their heart begins its decline. (It’s also a good reason to have a regular checkup with your doctor.)
Heart failure can involve the heart’s left side, right side or both sides. However, it usually affects the left side first.
Signs and Symptoms
People who experience any of the symptoms associated with heart failure, even if they are mild, should consult a doctor as soon as possible. Once a person is diagnosed, it’s important to keep track of symptoms and report any sudden changes.
Typical signs of heart failure include:
- Breathlessness or Shortness of Breath (Dyspnea) When the heart begins to fail, blood backs up in the veins attempting to carry oxygenated blood from the lungs to the heart. As fluid pools in the lungs, it interferes with normal breathing. In turn, you may experience breathlessness during exercise or other activities. As the condition worsens, shortness of breath may occur when at rest or asleep. These periods of breathlessness may leave you feeling exhausted and anxious.
- Fatigue As heart failure becomes more severe, the heart is unable to pump the amount of blood required to meet all of the body’s needs. To compensate, blood is diverted away from less-crucial areas, including the arms and legs, to supply the heart and brain. As a result, people with heart failure often feel weak (especially in their arms and legs), tired and have difficulty performing ordinary activities such as walking, climbing stairs or carrying groceries.
- Chronic Cough or Wheezing The fluid buildup in the lungs may result in a persistent cough or wheezing, that may produce phlegm (a thick, mucous-like substance) that may be tinged with blood.
- Rapid or Irregular Heartbeat The heart may speed up to compensate for its failing ability to adequately pump blood throughout the body. Patients may feel a fluttering in the heart (palpitations) or a heartbeat that seems irregular or out of rhythm. This often is described as a pounding or racing sensation in the chest.
- Lack of Appetite or Nausea When the liver and digestive system become congested they fail to receive a normal supply of blood. This can make you feel nauseous or full, even if you haven’t eaten.
- Mental Confusion or Impaired Thinking Abnormal levels of certain substances, such as sodium, in the blood and reduced blood flow to the brain can cause memory loss or disorientation, which you may or may not be aware of.
- Fluid Buildup and Swelling Because blood flow to the kidneys is restricted, the kidneys produce hormones that lead to salt and water retention. This causes swelling, also called edema, that occurs most often in the feet, ankles and legs.
- Rapid Weight Gain The fluid build-up throughout the body, may cause you to gain weight quickly.
These symptoms occur as the heart loses strength and the ability to pumped blood throughout the body. In turn, blood can back up and cause “congestion” in other body tissues, which is why heart failure sometimes is called “congestive.” In addition, excess fluid may pool in the failing portion of the heart and the lungs.
At the same time, the heart as well as other parts of the body attempt to adapt and make up for the deteriorating pumping ability. For example:
- Heart Grows Larger The muscle mass of the heart grows in an attempt to increase its pumping power, which works for a while. The heart chambers also enlarge and stretch so they can hold a larger volume of blood. As the heart expands, the cells controlling its contractions also grow.
- Heart Pumps Faster In an attempt to circulate more blood throughout the body, the heart speeds up.
- Blood Vessels Narrow As less blood flows through the arteries and veins, blood pressure can drop to dangerously low levels. To compensate, the blood vessels become narrower, which keeps blood pressure higher, even as the heart loses power.
- Blood Flow Is Diverted When the blood supply is no longer able to meet all of the body’s needs, it is diverted away from less-crucial areas, such as the arms and legs, and given to the organs that are most important for survival, including the heart and brain. In turn, physical activity becomes more difficult as heart failure progresses.
Although the body’s ability to compensate for the failing heart initially is beneficial, in the long run these adaptations contribute to the most serious cases of heart failure. For example:
- An enlarged heart eventually doesn’t function as well as a normal heart, and the extra muscle mass adds stress to the entire cardiovascular system.
- The organ systems from which blood has been diverted may eventually deteriorate because of an inadequate supply of oxygen.
- Narrowing of the blood vessels limits the blood supply and can contribute to conditions such as stroke, heart disease and clogged or blocked blood vessels in the legs and other parts of the body.
- Pumping blood too fast for too long can damage the heart muscle and interfere with its normal electrical signals, which can result in a dangerous heart rhythm disorder.
Eventually, the heart and body are unable to keep up with the added stress. If patients wait until they experience obvious symptoms of heart failure before seeing a doctor, the condition already may be life-threatening. If you experience any of these symptoms, consult your doctor as soon as possible.
How to Live Longer With Heart Failure
Can You Get Better After a Diagnosis of Heart Failure?
Heart failure is a chronic, progressive condition, which means it gets worse with time. But even though it doesn’t necessarily get better, managing heart failure the right way can help reduce symptoms and slow down the progression of the condition.
“I try to get patients to understand that this is not a death sentence,” Mountis says.
According to the CDC, 5.7 million people in the United States are living with heart failure. Several conditions can weaken the heart enough to lead to heart failure, including:
- Coronary heart disease or heart attack
- High blood pressure
- Faulty heart valves
- Damage to the heart muscle (cardiomyopathy)
- Inflammation of the heart muscle (myocarditis)
- Congenital heart defects
- Abnormal heart rhythms (heart arrhythmias)
- Other chronic disease, like diabetes, HIV, or thyroid disease
Depending on the stage and severity of condition, some individuals may need more aggressive treatment, Mountis adds. “But it is very possible to live a very good life with a diagnosis of heart failure.”
Living With Congestive Heart Failure: What to Expect
Yes, there are several lifestyle changes you should take into account if you’ve been diagnosed with congestive heart failure. But remember your diagnosis doesn’t mean you should necessarily stop doing things you love.
“You are supposed to be exercising — walking, biking, swimming, or doing light weight exercises,” says Mountis. The American Heart Association recommends at least 30 minutes of moderate intensity aerobic activity at least five days a week for optimal heart health. Avoid exercises that make you feel breathless, and make sure to talk to your doctor before starting a new exercise routine.
Your healthcare provider will also likely suggest dietary changes that can help reduce the swelling associated with congestive heart failure and slow the progression of the condition. Those changes may include following a low- or reduced-salt diet, or reducing how much fluid you drink to lessen the body’s water content.
Other lifestyle changes that can slow the progression of heart failure include:
- Quitting smoking
- Avoiding alcohol
- Maintaining a healthy weight
- Getting adequate sleep and rest
- Controlling high blood pressure
- Reducing stress
For some individuals, doctors may prescribe medication, like angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers, beta blockers, and aldosterone blockers. Other drugs that may be prescribed to reduce symptoms include diuretics, and vasodilator, digitalis, and anti-arrhythmia drugs.
If being on medication leads to an improvement of symptoms and your health, your doctor might advise you to stay on them for good, Mountis says, as they may help prolong your life.
Additional reporting by Brianna Wesley-Majsiak.
Low Ejection Fraction
What Is Ejection Fraction?
Ejection fraction, or EF, is a measurement that indicates how well your heart is functioning. This number tracks how much blood your heart is pumping out with each contraction.
Your ejection fraction is described as a percentage. If you’re healthy, your ejection fraction is generally between 55% and 70%. For instance, an ejection fraction of 60% means your heart is pumping 60% of your blood out of your left ventricle (its main pumping chamber) every time your heart beats.
What Is Low Ejection Fraction?
Low ejection fraction, sometimes called low EF, is the term we use to describe your ejection fraction if it falls below 55%. It means your heart isn’t functioning as well as it could. If a diagnostic test indicates that you have low ejection fraction, your doctor will want to thoroughly check you for a heart condition.
If you get to a 35% ejection fraction or below, you are at high risk of developing a dangerous arrhythmia and going into heart failure.
Low Ejection Fraction Causes
Many different heart and vascular diseases can lead to low ejection fraction, including:
- Cardiomyopathy: This condition causes areas of heart tissue to thicken. Learn more about cardiomyopathy.
- Coronary artery disease: This heart disease narrows or blocks the two main arteries that supply blood to your heart muscle. Learn more about coronary artery disease.
- Heart attack: Blockage of the heart’s arteries can permanently damage your heart muscle. Learn more about heart attack.
- Heart valve disease: This condition happens when heart valves do not open and close properly to allow proper blood flow through the heart. Learn more about heart valve disease.
- Systolic heart failure: This type of heart failure occurs when your heart’s left ventricle can’t pump blood forcefully enough.
Treating conditions, such as high blood pressure, thyroid disorders and coronary artery disease, as early as possible can help prevent heart failure. Treatment depends on the cause of the heart failure, how severe the symptoms are and how well the body is able to make up for the heart’s not being able to pump enough blood. While heart failure cannot be cured or made to go away, it is possible to make physical activity more comfortable, improve the quality of the life and prolong life.
Heart failure treatments focus on:
- Treating the underlying disorder that may be causing heart failure
- Controlling the elements that can make heart failure worse
- Treating the heart failure itself
- Drugs. In most cases, patients with heart failure have the disease for the rest of their lives and require specific drugs. A combination of drugs may be used, including ACE inhibitors,diuretics,beta-blockers and digoxin. These do not cure heart failure. They can relieve symptoms, improve heart function, slow the progress of the disease and reduce the risk of complications, hospitalization and premature death.
- Biventricular pacing, which is a promising new procedure to improve the output of blood from the heart. This is a type of pacemaker that coordinates the pumping of the lower left and right chambers. Less blood leaks through the mitral valve, and the muscles of the left lower chamber can pump better.
- Surgery to open blocked blood vessels in the heart can restore normal blood flow. Surgery to correct certain types of heart valve disease may also improve symptoms of heart failure.
- Ventricular assist devices (VAD) are machines that help a failing heart pump blood through the body. VADs have been used in patients as young as seven years old and as old as 70.
- The Cardiac Mechanical Assist Device Program at Cedars-Sinai Heart Center provides complete state-of-the-art mechanical support for patients with end-stage heart failure
- Heart transplant
- In most heart failure patients, treatment is also needed to correct or control related health problems (such as high blood pressure or coronary artery disease) and any other heart failure triggers (such as fever, anemia or infection)
- Lifestyle changes, such as losing weight, starting an exercise program approved by your doctor or in a reducing the amount of salt and fat in the diet, quitting smoking and avoiding alcohol
Heart failure that develops or gets worse quickly needs to be treated on an emergency basis in a hospital. If there is severe swelling in the lungs, oxygen will be given through a face mask. Diuretics can be injected, and drugs (such as nitroglycerin) can be given to improve comfort. In some cases it may be necessary to use a mechanical ventilator to assist in breathing. Certain hormones similar to adrenaline can be given on a short-term basis to help the heart muscle work more effectively.
Heart Failure: Understanding Heart Failure
2015 Medical Innovation: New drug for Heart Failure.
What is heart failure?
The term “heart failure” can be frightening. It does not mean the heart has “failed” or stopped working. It means the heart does not pump as well as it should.
Heart failure is a major health problem in the United States, affecting about 5.7 million Americans. About 550,000 new cases of heart failure occur each year. It is the leading cause of hospitalization in people older than 65.
If you have heart failure, you will enjoy better health and quality of life if you take care of yourself and keep yourself in balance. It is important to learn about heart failure, how to keep in good balance, and when to call the doctor.
How common is heart failure?
Almost 6 million Americans have heart failure, and more than 870,000 people are diagnosed with heart failure each year. The condition is the leading cause of hospitalization in people over age 65.
Heart failure and aging
Although the risk of heart failure does not change as you get older, you are more likely to have heart failure when you are older.
Women and heart failure
Women are just as likely as men to develop heart failure, but there are some differences:
- Women tend to develop heart failure later in life compared with men .
- Women tend to have heart failure caused by high blood pressure and have a normal EF.
- Women may have more shortness of breath than men do. There are no differences in treatment for men and women with heart failure.
What are the types of heart failure?
There are many causes of heart failure, but the condition is generally broken down into two types:
Heart failure with reduced left ventricular function (HF-rEF)
The lower left chamber of the heart (left ventricle) gets bigger (enlarges) and cannot squeeze (contract) hard enough to pump the right amount of oxygen-rich blood to the rest of the body.
Heart failure with preserved left ventricular function (HF-pEF)
The heart contracts and pumps normally, but the bottom chambers of the heart (ventricles) are thicker and stiffer than normal. Because of this, the ventricles can’t relax properly and cannot fill up all the way. Because there is less blood in the ventricles, less blood is pumped out to the rest of the body when the heart contracts.
What is ejection fraction?
Ejection fraction (EF) refers to how well your left ventricle (or right ventricle) pumps blood with each heart beat. Most times, EF refers to the amount of blood being pumped out of the left ventricle each time it contracts. The left ventricle is the heart’s main pumping chamber.
Your EF is expressed as a percentage. An EF that is below normal can be a sign of heart failure. If you have heart failure and a lower-than-normal (reduced) EF (HF-rEF), your EF helps your doctor know how severe your condition is.
How is EF measured?
Ejection fraction can be measured using:
- Echocardiogram (echo) – this is the most common way to check your EF
- Magnetic resonance imaging (MRI) scan of the heart
- Nuclear medicine scan (multiple gated acquisition MUGA) of the heart; also called a nuclear stress test
Why it’s important to know your EF
If you have a heart condition, it is important for you and your doctor to know your EF. Your EF can help your doctor determine the best course of treatment for you. Measuring your EF also helps your healthcare team check how well our treatment is working.
Ask your doctor how often you should have your EF checked. In general, you should have your EF measured when you are first diagnosed with a heart condition, and as needed when your condition changes.
What do the numbers mean?
Ejection Fraction (EF) 55% to 70%
- Pumping Ability of the Heart: Normal
- Level of Heart Failure/Effect on Pumping: Heart function may be normal or you may have heart failure with preserved EF (HF-pEF)
Ejection Fraction (EF) 40% to 54%
- Pumping Ability of the Heart: Slightly below normal
- Level of Heart Failure/Effect on Pumping: Less blood is available so less blood is ejected from the ventricles. There is a lower-than-normal amount of oxygen-rich blood available to the rest of the body. You may not have symptoms.
Ejection Fraction (EF) 35% to 39%
- Pumping Ability of the Heart: Moderately below normal
- Level of Heart Failure/Effect on Pumping: Mild heart failure with reduced EF (HF-rEF)
Ejection Fraction (EF) Less than 35%
- Pumping Ability of the Heart: Severely below normal
- Level of Heart Failure/Effect on Pumping: Moderate-to-severe HF-rEF. Severe HF-rEF increases risk of life-threatening heartbeats and cardiac dyssynchrony/desynchronization (right and left ventricles do not pump in unison)
Normal Heart. A normal left ventricular ejection fraction (LVEF) ranges from 55% to 70%. An LVEF of 65%, for example means that 65% of total amount of blood in the left ventricle is pumped out with each heartbeat. Your EF can go up and down, based on your heart condition and how well your treatment works.
HF-pEF. If you have HF-pEF, your EF is in the normal range because your left ventricle is still pumping properly. Your doctor will measure your EF and may check your heart valves and muscle stiffness to see how severe your heart failure is.
HF-rEF. If you have an EF of less than 35%, you have a greater risk of life-threatening irregular heartbeats that can cause sudden cardiac arrest/death. If your EF is below 35%, your doctor may talk to you about treatment with an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT). Your doctor may also recommend specific medications or other treatments, depending on how advanced your heart failure is. Less common treatment options include a heart transplant or a ventricular assist device (VAD). If your quality of life is very poor or your doctor has told you that your condition is very severe, please ask about other possible treatments.
Some patients have HF-rEF (and an EF lower than 40%) and signs of HF-pEF, such as a stiff (but not always enlarged) left ventricle.
What are the symptoms of heart failure?
There may be times that your symptoms are mild or you may not have any symptoms at all. This does not mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe, and they may come and go.
In general, heart failure gets worse over time. As it worsens, you may have more or different signs or symptoms. It is important to let your doctor know if you have new symptoms or if your symptoms get worse.
Common signs and symptoms of heart failure
- Shortness of breath or trouble breathing. You may have trouble breathing when you exercise, when you are resting or when lying flat in bed. Shortness of breath happens when fluid backs up into the lungs (congestion) or when your body isn’t getting enough oxygen-rich blood. If you wake up suddenly at night to sit up and catch your breath, the problem is severe and you need medical treatment.
- Feeling tired (fatigue) and leg weakness when you are active. When your heart does not pump enough oxygen-rich blood to major organs and muscles, you become tired and your legs may feel weak.
- Swelling in your ankles, legs and abdomen; weight gain. When your kidneys do not filter enough blood, your body holds onto extra fluid and water. Extra fluid in your body causes swelling edema and weight gain.
- Need to urinate while resting at night. Gravity causes more blood flow to the kidneys when you are lying down. So, your kidneys make more urine and you have the need to urinate.
- Dizziness , confusion, difficulty concentrating, fainting. You may have these symptoms because your heart is not pumping enough oxygen-rich blood to the brain.
- Rapid or irregular heartbeats (palpitations): When your heart muscle does not pump with enough force, your heart may beat faster to try to get enough oxygen-rich blood to major organs and muscles. You may also have an irregular heartbeat if your heart is larger than normal (after a heart attack or due to abnormal levels of potassium in your blood).
- A dry, hacking cough. A cough caused by heart failure is more likely to happen when you are lying flat and you have extra fluid in your lungs.
- A full (bloated) or hard stomach, loss of appetite or upset stomach (nausea).
It is very important for you to manage your other health conditions, such as diabetes, kidney disease, anemia, high blood pressure, thyroid disease and asthma or chronic lung disease. Some conditions have signs and symptoms that are similar to heart failure. If you have new or worsening non-urgent symptoms, tell our healthcare provider.
What causes heart failure?
Heart failure can be caused by many medical conditions that damage the heart muscle. Common conditions are:
- Coronary artery disease (also called coronary atherosclerosis or “hardening of the arteries”) affects the arteries that carry blood and oxygen to the heart (coronary arteries). The normal lining inside the arteries breaks down, the walls of the arteries become thick, and deposits of fat and plaque partially block the flow of blood. Over time, the arteries become very narrow or completely blocked, which causes a heart attack. The blockage keeps the heart from being able to pump enough blood to keep your organs and tissues (including your heart) healthy. When arteries are blocked, you may have chest pain (angina) and other symptoms of heart disease.
- Heart attack. A heart attack happens when a coronary artery suddenly becomes blocked and blood cannot flow to all areas of the heart muscle. The heart muscle becomes permanently damaged and muscle cells may die. Normal heart muscle cells may work harder. The heart may get bigger (HF-rEF) or stiff (HF-pEF).
- Cardiomyopathy. Cardiomyopathy is a term that describes damage to and enlargement of the heart muscle not caused by problems with the coronary arteries or blood flow. Cardiomyopathy can occur due to many causes, including viruses, alcohol or drug abuse, smoking, genetics and pregnancy (peripartum cardiomyopathy).
- Heart defects present at birth (congenital heart disease)
- High blood pressure (hypertension). Blood pressure is the force of blood pushing against the walls of your blood vessels (arteries). If you have high blood pressure, it means the pressure in your arteries is higher than normal. When blood pressure is high, your heart has to pump harder to move blood to the body. This can cause the left ventricle to become thick or stiff, and you can develop HF-pEF. High blood pressure can also cause your coronary arteries to become narrow and lead to coronary artery disease.
- Arrhythmia (abnormal heart rhythms, including atrial fibrillation)
- Kidney disease
- Obesity (being overweight)
- Tobacco and illicit drug use
- Medications. Some drugs used to fight cancer (chemotherapy) can lead to heart failure.
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Heart Diseases & Disorders
Electrical: Abnormal heart rhythms (arrhythmias) are caused by problems with the electrical system that regulates the steady heartbeat. The heart rate may be too slow or too fast; it may stay steady or become chaotic (irregular and disorganized). Some arrhythmias are very dangerous and cause sudden cardiac death, while others may be bothersome but not life threatening.
Circulatory: High Blood Pressure and coronary artery disease (causing blockages in the pipes (arteries) that supply blood to the heart) are the main causes of blood vessel disorders. They can result in a stroke or heart attack, which can be devastating. Fortunately, there are many preventative and treatment options.
Structural: Heart muscle disease (cardiomyopathy) and congenital abnormalities (problems in the development of the heart and blood vessels which are present from birth) are two problems that can damage the heart muscle or valves.
Arrhythmias that start in the heart’s upper chambers, the atria, include:
- Atrial Fibrillation (AF or AFib)
More than 2 million people in the U.S. have atrial fibrillation. In AFib, the heartbeat is irregular and rapid due to disorganized signals from the heart’s electrical system. The upper chambers of the heart may beat as often as 300 – 400 times a minute, about four times faster than normal. Though AFib isn’t life threatening, it can lead to other rhythm problems, feeling tired all the time, and heart failure (with symptoms such as filling up with fluid, swelling of the hands, legs and feet, and shortness of breath). People with AFib are five times more likely to have a stroke than people without the condition. Doctors often prescribe blood thinners (anticoagulants) to patients with AFib to reduce this higher risk of stroke.
- Atrial Flutter (AFL)
Atrial flutter is similar to AFib because it also causes a fast beat in the atria. However, AFL is caused by a single electrical wave that circulates very rapidly in the atrium, about 300 times a minute. This leads to a very fast, but steady, heartbeat. It can also increase the risk of a stroke.
- Sick Sinus Syndrome (SSS);
Sick sinus syndrome is not a disease, but a group of signs or symptoms that show that the heart’s natural electrical pacemaker, the sinus node, is not working properly. In SSS, the heart rate can alternate between slow (bradycardia) and fast (tachycardia), often in combination with atrial fibrillationor atrial flutter. Treatment of SSS usually involves implanting a pacemaker, often along with medication.
- Sinus Tachycardia
A harmless faster rhythm, sinus tachycardia is a normal increase in heart rate that happens with fever, excitement, and exercise. There is no need for treatment, except in cases when it is caused by an underlying problem, such as anemia (a low blood count) or hyperthyroidism (overactive thyroid gland), or rarely, happens frequently and without a clear cause (inappropriate sinus Tachucardia).
Arrhythmias that occur in the heart’s lower chambers, the ventricles, include:
- Ventricular Tachycardia (VT)
A life-threatening arrhythmia, ventricular tachycardia is usually seen along with other serious heart disease but sometimes happens in people with normal hearts. Because VT can lead to ventricular fibrillation (a dangerously fast and disorganized heartbeat), it is a serious condition that needs aggressive treatment and follow up.
Treatment options include surgery, radiofrequency ablation (scarring or burning the area of heart tissue that triggers the abnormal rhythm), and/or medication. People with VT are often protected by a defibrillator (a device that can shock the heart out of the dangerous heartbeat) that is implanted in the body.
- Ventricular Fibrillation (VF)
Sudden Cardiac Arrest (SCA) caused by ventricular fibrillation is the cause of half of all heart related deaths. In VF, the heartbeat is fast and chaotic, causing the lower heart chambers, or ventricles, to spasm. Sometimes, a heart attack (blockage of the heart pipes/arteries) can lead to VF. VF is sudden, happens without warning, and stops the heart from working. The lack of oxygen to the body, especially to the brain, is deadly. SCA is caused by an electrical problem and although it can be triggered by a heart attack(myocardial infarction), a circulatory (plumbing) problem caused by clogged blood vessels that cut off the supply of blood to the heart, it is not the same as a heart attack. Though CPR may help, the only truly effective VF treatment is defibrillation, which uses paddles or electrodes to “shock” the heart back to normal rhythm. Without treatment, a person with VF will pass out suddenly and die.
Other terms to know include:
- Premature Contractions
Extra, early, or “skipped” beats are the most common cause of irregular heart rhythms. These can start in the upper or lower chambers of the heart (atrial or ventricular premature contractions).
- Long QT Syndrome (LQTS)
Long QT Syndrome is a disorder of the electrical system. It can be inherited, brought on by taking certain medications, or caused by a combination of both. People with LQTS are at risk for VF, the most dangerous heart rhythm that causes sudden death.
- Heart Block
When electrical signals from the upper chambers of the heart (atria) cannot travel to the lower chambers (ventricles), heart block happens. The lower chambers of the heart (ventricles) then beat too slowly, decreasing the amount of oxygen that gets to the body and brain. This causes a slow pulse and can result in a lack of energy, light headedness or Fainting.
- Syncope (Fainting)
Fainting, or feeling as if one might pass out, can be caused by serious heart rhythm disorders and needs to be evaluated carefully. Sometimes the cause is not heart related, as in cases of low blood sugar, but it can still be dangerous due to the risk of injuries from falling.
- Heart Attack (Myocardial Infarction)
When arteries become so clogged that the flow of blood to the heart is reduced or stopped, the lack of oxygen can damage or kill the heart muscle, causing a heart attack. Knowing the symptoms of a heart attack and getting immediate emergency treatment can limit or prevent heart muscle damage.
Strokes (brain attacks), although not true heart disorders, are caused by blockage or reduced blood flow to the brain. While some strokes occur when a blood vessel bursts, most happen due to clogged or blocked vessels to the brain, in the same way clogged vessels in the heart can cause a heart attack. Abnormal heart rhythms such as atrial fibrillation and atrial flutter can lead to the formation of blood clots in the heart. Such blood clots can break off and travel to the brain, block a vessel and cause a stroke. All strokes pose serious health threats.
- Heart Failure
When the heart muscle is too weak to effectively pump blood through the body, heart failure, or cardiomyopathy, sets in. Early diagnosis and treatment can stop or slow down the worsening of heart failure.
- Heart Valve Problems
Heart valve problems can be inherited or develop on their own, affecting the heart’s ability to push blood efficiently from chamber to chamber, and out to the rest of the body. Medication, surgery, and the placement of new valves using catheters (thin tubes placed in the vessels and heart) are treatment options.
Good news! Many people with a low ejection fraction (or EF) have successfully improved it.
Better heart failure management (HF) can lead to a better ejection fraction. By managing your heart failure carefully and following your treatment plan, you may be able to help yourself experience fewer symptoms and achieve a greater sense of well-being. As an added bonus, you may also see an improvement – or even a recovery – of your heart’s ejection fraction.
People with improved or recovered ejection fractions, as a whole, tend to have fewer hospitalizations and better overall outcomes.
1. Talk with your healthcare provider about improving your EF.
Your healthcare provider can help you draft a realistic plan. What works for another person, may not be right for you. Ask your doctor or other healthcare provider for his or her recommendations, and accept the encouragement and support of family members or friends who can help you reach your goals.
Before you decide on your next steps, first discuss the following questions with your healthcare provider:
- What is my EF?
- Why is my EF low and how does it affect my health?
- Which lifestyle changes or medications are likely to help me? Is there anything I should avoid?
- If I track my heart failure symptoms, how might that help improve my outcome?
- When should I plan to retest my EF?
2. Treat any known causes of heart failure.
Find out if your HF is clearly linked to an underlying cause. Several risk factors are associated with heart failure like high blood pressure, or hypertension, diabetes and metabolic syndrome. By managing those conditions, you may be able to help your heart failure and your ejection fraction improve.
Know your plan and follow it carefully. If you have been prescribed medications for heart failure, diabetes, high blood pressure or another underlying cause, taking your prescribed medication may also improve your ejection fraction. Over time, as the medications are working, your heart may be able to recover, strengthen and perform better.
3. Get the right amount of physical activity.
Exercise helps most people with HF, and some patients who follow an exercise plan may see improvements in their EF. Research shows that being active can help people living with heart failure by reducing symptoms, improving mood and even increasing the heart’s ability to pump blood. If your heart failure is stable, and you have your doctor’s okay, do what moves you.
Here are some exercise tips to keep in mind.
- Consider a cardiac rehab program. It offers some unique benefits, and you may even be able to join a supervised home-based exercise program. Talk to your healthcare provider to see if you qualify. Explore our cardiac rehab resources.
- Work toward 20-30 minutes of cardio. Most HF exercise programs focus on improving your ability to sustain aerobic activity.
- Explore strength training. Studies show that some people living with HF benefit from resistance or weight training, which also may contribute to an improved EF. Be sure to talk with your healthcare provider before starting and go easy on yourself at first.
- Start with walking. If you’re just getting started, walking is a good and safe way to begin. It’s easy to do, and it may help you learn to pace yourself. Your provider may do a 6-minute walk test to help measure your improvements over time. You simply start by seeing how far you can walk in one six minute session.
- Begin and end with a warm-up and cool down. If you use a fitness tracker or heart rate monitor, you may benefit from setting heart rate zones with your healthcare provider. A brief warm up and cool down can help your body transition smoothly in and out of your exercise zone and reduce symptoms of dizziness and/or lightheadedness.
4. Pay attention to your weight.
Your weight is important. Tracking your weight can give you important clues about how well your heart is managing its load.
- Track and respond to weight fluctuations. You may notice patterns that help you respond appropriately to situations before they get worse.
- Maintain a healthy body weight. A healthy body mass makes it easier for your heart and blood vessels to circulate blood and manage fluid levels.
5. Know your sodium limits and regulate fluids.
- Check your sodium intake. The average American consumes about 3,400 milligrams of sodium per day, which can result in the body holding excess fluids and create an added strain on the heart.
- Follow your sodium recommendations. For most patients with heart failure, the AHA recommendations of no more than 1,500 milligrams of sodium per day are appropriate, but your treatment plan may have an alternate recommendation. Read labels and follow your treatment plan carefully.
- Discover ways to help you reduce sodium in your diet.
6. Eliminate harmful substances.
- Abstain from alcohol. Alcohol can increase the risk of heart failure and worsen symptoms. By eliminating alcohol, the signs and symptoms of heart failure often improve.
- Quit smoking. Smoking cigarettes is especially hazardous to people with heart failure. Discover the resources that can help you quit for good.
- Quit any usage of cocaine or amphetamines. These substances are strongly associated with HF and should be eliminated to improve your chances for a recovered EF. Do not stop taking any prescribed medications without discussing with your healthcare provider
7. Lower your stress.
- Care for your emotional well-being. Although the correlations between heart failure and stress are unclear, being stressed can increase heart rate and blood pressure, two things that can worsen heart failure symptoms.
- Practice stress-reducing habits. Although we cannot always control what happens to us, we can practice skills for lowering stress. Whether or not stress-reduction has a direct affect on your ejection fraction, it never hurts to build up your tools for emotional well-being. Read some quick tips for lowering stress or visit our Support Network to connect with others.
What results can I expect?
Although individual results may vary, the efforts you put into improving your heart’s ejection fraction can have additional positive results. You may also discover that you feel better and experience fewer symptoms as well. The investment you are making to help yourself recover is your best pathway for taking control of your health.
Connect with others on our Support Network where people are encouraging each other every day to achieve their best health.
Download our sheet: HF and Your Ejection Fraction Explained (PDF) | Spanish (PDF)