If your doctor tells you that you or a loved one has heart failure with reduced ejection fraction, what does that actually mean? First, it’s important to recognize that heart failure does not actually mean the heart has stopped working: it means that the heart’s ventricles are not relaxing as they normally do, or the heart is not pumping as much oxygen-rich blood to the body as it should be.
This first type of heart failure, in which the ventricles do not relax with each heartbeat, is called heart failure with preserved ejection fraction. The type of heart failure in which the weakened heart doesn’t contract with enough force, and therefore doesn’t pump enough blood throughout the body, is called heart failure with reduced ejection fraction.
What Is Ejection Fraction?
To understand the term ‘ejection fraction’, we should first briefly review how the heart works. Veins transport deoxygenated blood to the right atrium of the heart, which contracts and causes the blood to move to the right ventricle. Once the ventricle is full, the tricuspid valve closes so that blood cannot flow backward, and the ventricle contracts in order to push blood into the pulmonary artery and back out to the lungs, where it is oxygenated.
The ejection fraction is a measure of the volume of blood that the left ventricle pumps with each contraction. With a healthy heart, the ejection fraction is usually between 50% and 75% of the heart’s total volume of blood. Someone who has an ejection fraction between 40% and 55% could have some heart damage, but does not necessarily have heart failure. Someone who has an ejection fraction below 40% likely has heart failure with reduced ejection fraction.
What Should Someone with Reduced Ejection Fraction Expect?
Signs of heart failure with reduced ejection fraction may include feeling more tired than usual, becoming easily winded (short of breath), and having swollen feet. If you have been experiencing these symptoms, your doctor will likely want to check your heart with an echocardiogram. This involves using an imaging machine that will generate a video of the heart using sound waves, allowing a cardiologist to measure your ejection fraction.
Entresto from Novartis
If you do have heart failure with reduced ejection fraction, there are medications that your doctor can prescribe to help protect your heart from more damage and serious complications, such as a heart attack. ACE inhibitors (e.g. Capoten, Vasotec) are commonly prescribed; these heart drugs help relax blood vessels and lower blood pressure, which takes some off the strain off the heart. Angiotensin II receptor blockers (e.g. Atacand, Cozaar) are another option; these drugs dilate blood vessels in order to lower blood pressure. There’s also Entresto, a new combination drug that contains a neprilysin inhibitor and angiotensin II receptor blocker. Entresto is typically used alongside other heart failure treatments in the place of an ACE inhibitor or angiotensin receptor blocker.
If you or a loved one has been diagnosed with heart failure, it’s important that you discuss treatment options with your doctor. The best course of treatment will depend on a number of factors, including medical history and other prescribed drugs.