Ejection Fraction: Normal Range, Low Range, and Treatment (2022)

Ejection fraction is a measurement doctors use to calculate the percentage of blood that leaves your heart each time it contracts.

As your heart beats, it pumps (ejects) blood into your body from the two lower muscular chambers, known as the left and right ventricles. Between beats, when your heart relaxes, the two ventricles fill up with blood.

However, it takes more than a single contraction to pump all the blood out of a ventricle. Ejection fraction is a test your doctor can use to determine the percentage of blood that leaves the left ventricle each time your heart beats, and to understand how well your heart works.

Ejection fraction can help diagnose heart failure.

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Generally, your left ventricle is the one measured for ejection fraction. It does the heavy lifting in your body, pumping blood to almost all your major organs.

(Video) Ejection Fraction Measurement and Heart Failure

However, current research suggests that the right ventricle shouldn’t be ignored when determining ejection fraction of the right heart.

An accurate left ventricle ejection fraction (LVEF) reading can be measured through a variety of imaging techniques. The most common ejection fraction testing measures include:

  • Echocardiogram. An echocardiogram uses sound waves to take images of your heart. A 2012 research article suggests that 3-D images provide the best and most accurate readings.
  • Cardiac MRI (C-MRI). A C-MRI is an image-based test that uses a magnetic field, radio waves, and a computer to create detailed images of the inside of your heart.
  • Cardiac catheterization. In this procedure, your doctor inserts a hollow tube into a large blood vessel to monitor your heart function. During the catheterization, a coronary angiography is also performed. A dye is injected into the catheter. Then, an X-ray monitors the blood flowing throughout your heart.
  • Cardiac nuclear medicine scan. Trace amounts of radioactive materials are injected into your bloodstream. They’re then detected by cameras that produce images of your heart and its mechanisms.
  • Cardiac CT scan. This X-ray procedure can give a representation of heart size and, with gated images, heart function.

According to cardiology experts, LVEF results are typically classified as follows for people ages 18 and older:

LVEF rangeMenWomen
Normal range52–72%54–74%
Mildly abnormal range41–51%41–53%
Moderately abnormal range30–40%30–40%
Severely abnormal rangeless than 30%less than 30%
  • High LVEF. An LVEF measurement that’s above 72 percent for men and above 74 percent for women may be an indication of a heart condition such as hypertrophic cardiomyopathy. This is when the heart muscle becomes thicker than normal and interferes with the heart’s pumping function. It’s a common cause of sudden cardiac arrest.
  • Normal. Even if you have a normal range LVEF, it doesn’t necessarily mean your heart is “normal.” Some people can have heart failure with a condition that’s known as heart failure with preserved ejection fraction (HFpEF). See below for more details.
  • Mildly reduced. An ejection fraction range between 41 and 51 percent for men and between 41 and 53 percent for women is classified as mildly reduced. It could be a sign of heart damage, perhaps from a heart condition or a previous heart attack.
  • Sign of heart failure. An LVEF below 40 percent is heart failure with reduced ejection fraction (HFrEF). It can also be due to cardiomyopathy, which is when your heart muscle weakens, making your heart less effective at pumping blood to the rest of your body.

What are the types of heart failure?

(Video) What Is Ejection Fraction And Its Link To Heart Failure?

Heart failure with reduced left ventricular function (HFrEF)

An ejection fraction below 40 percent is classified as heart failure with a reduced ejection fraction (HFrEF). It occurs when one of your heart’s chambers isn’t able to contract properly. Medications can treat it.

Symptoms may include:

  • shortness of breath
  • exhaustion
  • heart palpitations
  • dizziness, confusion, lightheadedness
  • swelling in your ankles, legs, or abdomen
  • exercise intolerance

You may also have a greater risk of irregular heart rates that can be life threatening.

If your ejection fraction is below 35 percent, your doctor will likely recommend other treatments, like an implantable cardioverter defibrillator or a pacemaker, to help regulate your heart rhythm.

Heart failure with preserved left ventricular function (HFpEF)

With this type of heart failure, you have a preserved, or normal, ejection fraction. It occurs when your left ventricle doesn’t relax properly.

This may be due to a thickened heart muscle or heart muscle stiffness. It can lead to less blood being pumped from your heart to the rest of your body.

Symptoms may include fatigue and shortness of breath during exercise. HFpEF can be the result of aging, diabetes, or high blood pressure.

As we age, our hearts do too. Heart walls thicken and lose some of their capacity to contract and relax as efficiently as they should.

But a low ejection fraction reading can also indicate some form of heart damage, including:

  • Cardiomyopathy. Cardiomyopathy is a weakening of the heart muscle caused by thickening or dilation of the heart muscle. This makes it harder for your heart to pump properly.
  • Heart attack and coronary artery disease. A heart attack occurs when one or more of your arteries become blocked, causing damage to the heart muscle. Coronary artery disease can narrow or block your heart’s left and right arteries, making it more difficult for blood to flow to your heart.
  • Heart valve disease. This occurs when one or more of the valves in your heart don’t open or close properly. This can disrupt the blood flow through your heart and body.
(Video) How To Increase Ejection Fraction

A high ejection fraction reading can indicate a heart condition known as hypertrophic cardiomyopathy. This condition abnormally thickens parts of your heart muscle without an obvious cause.

Hypertrophic cardiomyopathy is often genetic. It’s tough for doctors to diagnose because many people don’t have symptoms.

(Video) Ejection Fraction | Heart Health | Rose Heart & Vascular Center

For a small number of people, hypertrophic cardiomyopathy can cause serious abnormal heart rhythms (arrhythmias) that require treatment.

If you have a family history of hypertrophic cardiomyopathy, let your doctor know so they can monitor you over time.

There are a variety of treatment options for abnormal ejection fraction. Some of the most common treatments include:

  • Angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), or beta-blockers. These medications can reduce the amount of hormones that weaken your heart muscle. They can also slow the progression of heart disease.
  • Diuretics. These drugs can help get rid of excess fluid that’s causing swelling and shortness of breath.
  • Eplerenone or spironolactone. These drugs help you eliminate excess fluid and can help decrease stiffening of your heart.
  • Hydralazine/nitrate. These two drugs have been successful in lowering blood pressure in people who still have symptoms when taking ACE, ARBs, and beta-blockers.
  • Angiotensin receptor-neprilysin inhibitor (ARNI). This drug combines two drugs (sacubitril and valsartan) that reduce blood pressure and the strain on your heart.
  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors. If you have type 2 diabetes, this type of drug may help reduce the risk of heart failure and serious kidney complications.
  • Biventricular pacemaker. This pacemaker helps synchronize the contractions of your left and right ventricles so they’re working to their highest capacity.
  • Implantable cardiac defibrillator. This device can be directly implanted into your chest. It sends small electrical triggers to your heart to keep it beating regularly.

The bottom line

(Video) Is 45% of ejection fraction normal!? How can one improve it? - Dr. Durgaprasad Reddy B

Ejection fraction is a test your doctor can use to determine the percentage of blood that leaves a ventricle each time your heart beats, and to understand how well your heart works.

A normal ejection fraction range is between 52 and 72 percent for men and between 54 and 74 percent for women. An ejection fraction that’s higher or lower may be a sign of heart failure or an underlying heart condition.

In general, the outlook for people with an abnormal ejection fraction result is encouraging. In most cases, with diligent care, the right treatment and medications, and certain lifestyle changes, you can manage your symptoms and continue living a high-quality life.

FAQs

What is the treatment for low ejection fraction? ›

Low ejection fraction treatment

We may recommend: Lifestyle changes, such as getting exercise, losing weight, quitting smoking or reducing salt. Medication, such as beta blockers or diuretics, to help improve your heart function or get rid of excess fluids.

How can you improve the ejection fraction? ›

How to improve your ejection fraction
  1. Partner up with a doctor. Whether it's a cardiologist or your primary care physician, talk to a doctor about your symptoms. ...
  2. Be a heart detective. Put this on your doctor's to-do list, too. ...
  3. Get moving. ...
  4. Watch your weight. ...
  5. Go on a salt strike. ...
  6. Just say no. ...
  7. Say goodbye to stress.
12 Aug 2019

How serious is a low ejection fraction? ›

Ejection fraction is measured as a percentage of the total amount of blood in your heart that is pumped out with each heartbeat. A normal ejection fraction is 50 percent or higher. An ejection fraction below 40 percent means your heart isn't pumping enough blood and may be failing.

Can you live a normal life with a low ejection fraction? ›

A low Ejection Fraction is a serious health risk

If untreated, Sudden Cardiac Arrest can lead to death within minutes. If you have a low ejection fraction, your doctor may prescribe medications, recommend lifestyle adjustments or suggest other therapies.

Can EF improve with medication? ›

Classes of medications that may help improve ejection fraction and heart failure prognosis include: Beta blockers. ACE inhibitors. Angiotensin receptor blockers.

Can ejection fraction improve in 3 months? ›

If after 3 to 6 months of therapy the EF has increased (taking into account the variability in repeated readings), the therapy may be deemed successful. If the EF has risen to a normal level or to at least more than 40 or 45%, the patients may be classified as having “improved” or even “recovered” EF.

Which drugs increase ejection fraction? ›

The mainstay of medical treatment for patients with heart failure with reduced ejection fraction (HFrEF) are beta blockers (BB), angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA).

Can you live with 20% ejection fraction? ›

Conclusion: Three year survival is low when ejection fraction is very low. However, once the ejection fraction is < or =20% ejection fraction is no longer a predictor of mortality.

What supplements help ejection fraction? ›

Results: Clinical trials reported that the intake of some nutraceuticals (hawthorn, coenzyme Q10, L-carnitine, Dribose, Carnosine, Vitamin D, Some probiotics, Omega-3 PUFAs, Beet nitrates) is associated with improvements in functional parameters such as ejection fraction, stroke volume and cardiac output in HF patients ...

Can you exercise with low ejection fraction? ›

Exercise and Heart Failure with Reduced Ejection Fraction: HFrEF. The American Heart Association has advised that regular exercise training is safe and does not increase cardiac events in stable HFrEF patients. Prior studies have also observed a cardiovascular benefit from exercise among patients with HFrEF.

How can I increase my heart pumping? ›

7 powerful ways you can strengthen your heart
  1. Get moving. Your heart is a muscle and, as with any muscle, exercise is what strengthens it. ...
  2. Quit smoking. Quitting smoking is tough. ...
  3. Lose weight. ...
  4. Eat heart-healthy foods. ...
  5. Don't forget the chocolate. ...
  6. Don't overeat. ...
  7. Don't stress. ...
  8. Related Stories.
9 Feb 2017

Can you live with 10% ejection fraction? ›

A normal heart pumps blood out of its left ventricle at about 50 to 70 percent — a measurement called an ejection fraction, according to the American Heart Association. “Don was at 10 percent, which is basically a nonfunctional heart,” Dow said. “When a heart is pumping at only 10 percent, a person can die very easily.

How long can you live with an EF of 40? ›

Patients with an ejection fraction of under 40% may be at greater risk of dying from CHF. However, a 2017 study reported that 5-year life expectancy was poor among all patients admitted to hospital with heart failure regardless of ejection fraction, and estimated 5-year mortality to be 75.4%.

What causes ejection fraction to drop? ›

Some things that may cause a reduced ejection fraction are: Weakness of the heart muscle, such as cardiomyopathy. Heart attack that damaged the heart muscle. Heart valve problems.

Can Stress Affect Your ejection fraction? ›

An increase in EF was seen during emotional stress (from 0.45 +/- 0.09 to 0.51 +/- 0.13, P less than 0.001). This increase was comparable to that observed during exercise (0.52 +/- 0.14) and eating (0.52 +/- 0.10, P less than 0.001). In contrast, cold exposure caused a decrease in EF (0.43 +/- 0.13, P less than 0.05).

Can exercise increase ejection fraction? ›

It's important to remember that exercise will not improve your ejection fraction (the percentage of blood your heart can push forward with each pump). However, it can help to improve the strength and efficiency of the rest of your body.

Does a pacemaker increase ejection fraction? ›

Biventricular pacemaker is a special pacemaker, which is used to synchronize the contractions of the left ventricle with the right ventricle, to improve the ejection fraction in patients with severe and moderately severe symptoms of heart failure.

Can Yoga increase ejection fraction? ›

Studies have demonstrated the effect of yoga on improvement of lipid profiles,11 blood pressure,12 psychological well-being, regression of atherosclerosis when combined with dietary and other lifestyle modifications,13,14 and left ventricular ejection fraction (LVEF) in coronary heart patients.

What is the minimum ejection fraction? ›

A low ejection fraction (or low EF) is typically 45 or less and can be evidence of heart failure or cardiomyopathy (a disease of the heart muscle). The heart's ejection fraction (EF) refers to the amount – or percentage – of blood pumped (or ejected) out of the heart's left ventricle with each contraction.

What is normal ejection fraction for a 70 year old? ›

An ejection fraction of 50 percent to 65 percent is considered normal.

How serious is a 25 ejection fraction? ›

Normal EF is in the range of 55% to 70%. As the percentage falls, it tells the doctor that the heart failure is getting worse. In general, if the EF falls below 30%, it's relatively severe. A reading of 20% or below is very severe heart failure.

What is the latest treatment for heart failure? ›

Today, the U.S. Food and Drug Administration approved Farxiga (dapagliflozin) oral tablets for adults with heart failure with reduced ejection fraction to reduce the risk of cardiovascular death and hospitalization for heart failure.

What is the first line treatment for heart failure? ›

After a patient has been diagnosed with a type, stage, and class, treatment can be determined. First-line drug therapy for all patients with HFrEF should include an angiotensin-converting enzyme (ACE) inhibitor and beta blocker. These medications have been shown to decrease morbidity and mortality.

Which medicine is best for heart failure? ›

Some of the main medicines for heart failure include:
  • ACE inhibitors.
  • angiotensin-2 receptor blockers (ARBs or AIIRAs)
  • beta blockers.
  • mineralocorticoid receptor antagonists.
  • diuretics.
  • ivabradine.
  • sacubitril valsartan.
  • hydralazine with nitrate.

What are 4 stages of heart failure? ›

There are four stages of heart failure - stage A, B, C and D - which range from high risk of developing heart failure to advanced heart failure.

Can you have low ejection fraction without heart failure? ›

Left ventricular (LV) remodeling and reduced ejection fraction (EF) should be distinguished from the syndrome of clinical heart failure (HF). When LVEF is reduced (! 40%), but there are no signs and symptoms of HF, the condition frequently is referred to as asymptomatic LV dys- function (ALVD).

What is stage 4 heart failure life expectancy? ›

Most people with end-stage heart failure have a life expectancy of less than 1 year. 4.

What vitamins can I take for heart failure? ›

Vitamin E and vitamin C are probably the best vitamin antioxidants. If you already have heart disease, vitamin E might reduce your risk of a future heart attack. Vitamin C helps vitamin E work better in your body. It also improves the way your arteries work.

Can CoQ10 improve ejection fraction? ›

A meta-analysis showed that CoQ10 resulted in an improvement in ejection fraction of 3.7% (95%CI 1.59-5.77) and the mean increase in cardiac output was 0.28 L/minute (95%CI 0.03-0.53). In a subgroup analysis, studies with patients not taking ACE inhibitors found a 6.7% increase in ejection fraction.

Is ejection fraction related to blood pressure? ›

Conclusion: systolic blood pressure lower than 120mmHg is associated with reduced cardiac ejection fraction in coronary arteries. There was a relationship between increased diastolic blood pressure and elevated left ventricular ejection fraction in women with coronary disease.

Is 45 EF considered heart failure? ›

Many doctors consider a normal ejection fraction to be 55% to 75%. If yours is 50% or lower, it's a sign that your heart -- usually your left ventricle -- may not pump out enough blood. There's a gray area when your EF is between 50% and 55%. Some experts call this borderline.

Can heart failure get better? ›

Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger. Doctors sometimes can correct heart failure by treating the underlying cause.

Which drink is best for heart? ›

Drink: Water

Plain old water might be the best thing to drink for overall health, and that includes your heart.

Which exercise is best for heart? ›

Examples: Brisk walking, running, swimming, cycling, playing tennis and jumping rope. Heart-pumping aerobic exercise is the kind that doctors have in mind when they recommend at least 150 minutes per week of moderate activity.

What is stage 2 heart failure? ›

Stage 2 of Congestive Heart Failure

Stage two of congestive heart failure will produce symptoms such as fatigue, shortness of breath, or heart palpitations after you participate in physical activity. As with stage one, lifestyle changes and certain medication can help improve your quality of life.

How long can a 70 year old live with heart failure? ›

Mean age at diagnosis was 70 years (SD, 10.8 years) and median survival was 1.7 years for men and 3.2 years for women.

What is Stage D heart failure? ›

Stage D heart failure describes advanced progression of the heart failure syndrome characterized by structural abnormalities of the heart and severe resting symptoms despite optimal medical, surgical, and device therapy. The terms “stage D” and “advanced” are used interchangeably in the present document.

How long can a 50 year old live with congestive heart failure? ›

Although there have been recent improvements in congestive heart failure treatment, researchers say the prognosis for people with the disease is still bleak, with about 50% having an average life expectancy of less than five years. For those with advanced forms of heart failure, nearly 90% die within one year.

Is it normal to sleep a lot with heart failure? ›

Still, it's serious. As your heart works overtime, it can cause tiredness, shortness of breath and a feeling of being simply worn out. Such are the signs of fatigue, one of the most common symptoms of congestive heart failure.

Can anxiety lower ejection fraction? ›

We also examined whether changes in haemodynamic and neurohormonal parameters are related to changes in LVEF during mental stress. The LVEF decreased from 54.8% +/- 17.7% to 49.8% +/- 16.2% with mental stress (P < 0.0005).

Is ejection fraction genetic? ›

Heart Failure with Preserved Ejection Fraction

Heart disease caused by these conditions may lead to a thickening of the heart's walls. Less commonly, heart failure with preserved ejection fraction is genetic, or inherited. This is known as hypertrophic cardiomyopathy, and it can affect people of all ages.

Can you reverse heart failure? ›

Although heart failure is a serious condition that progressively gets worse over time, certain cases can be reversed with treatment. Even when the heart muscle is impaired, there are a number of treatments that can relieve symptoms and stop or slow the gradual worsening of the condition.

Does low ejection fraction always mean heart failure? ›

A low ejection fraction lets a doctor know that the active pumping phase of the heart isn't working. It's usually tied to some, but not all, types of heart failure. Heart failure with a low EF is called "systolic" heart failure.

Can you live with 10% ejection fraction? ›

A normal heart pumps blood out of its left ventricle at about 50 to 70 percent — a measurement called an ejection fraction, according to the American Heart Association. “Don was at 10 percent, which is basically a nonfunctional heart,” Dow said. “When a heart is pumping at only 10 percent, a person can die very easily.

What is normal ejection fraction for a 70 year old? ›

An ejection fraction of 50 percent to 65 percent is considered normal.

Does walking improve ejection fraction? ›

Official answer. Exercise including walking can improve ejection fraction if it is done 3 to 5 times per week for at least 20 to 40 minutes per session at a moderate-intensity pace, but it must be built up gradually.

Which drugs increase ejection fraction? ›

The mainstay of medical treatment for patients with heart failure with reduced ejection fraction (HFrEF) are beta blockers (BB), angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA).

Can you live with 20% ejection fraction? ›

Conclusion: Three year survival is low when ejection fraction is very low. However, once the ejection fraction is < or =20% ejection fraction is no longer a predictor of mortality.

What causes ejection fraction to drop? ›

Some things that may cause a reduced ejection fraction are: Weakness of the heart muscle, such as cardiomyopathy. Heart attack that damaged the heart muscle. Heart valve problems.

What is stage 2 heart failure? ›

Stage 2 of Congestive Heart Failure

Stage two of congestive heart failure will produce symptoms such as fatigue, shortness of breath, or heart palpitations after you participate in physical activity. As with stage one, lifestyle changes and certain medication can help improve your quality of life.

Can a damaged heart repair itself? ›

The heart is unable to regenerate heart muscle after a heart attack and lost cardiac muscle is replaced by scar tissue. Scar tissue does not contribute to cardiac contractile force and the remaining viable cardiac muscle is thus subject to a greater hemodynamic burden.

How long can you live with an EF of 40? ›

Patients with an ejection fraction of under 40% may be at greater risk of dying from CHF. However, a 2017 study reported that 5-year life expectancy was poor among all patients admitted to hospital with heart failure regardless of ejection fraction, and estimated 5-year mortality to be 75.4%.

How do doctors test for heart failure? ›

blood tests – to check whether there's anything in your blood that might indicate heart failure or another illness. an electrocardiogram (ECG) – this records the electrical activity of your heart to check for problems. an echocardiogram – a type of ultrasound scan where sound waves are used to examine your heart.

What are the 4 stages of heart failure? ›

There are four heart failure stages (Stage A, B, C and D). The stages range from "high risk of developing heart failure" to "advanced heart failure."
...
Stage C
  • Shortness of breath.
  • Feeling tired (fatigue).
  • Less able to exercise.
  • Weak legs.
  • Waking up to urinate.
  • Swollen feet, ankles, lower legs and abdomen (edema).
21 Jan 2022

Can you recover ejection fraction? ›

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.

Can Stress Affect Your ejection fraction? ›

An increase in EF was seen during emotional stress (from 0.45 +/- 0.09 to 0.51 +/- 0.13, P less than 0.001). This increase was comparable to that observed during exercise (0.52 +/- 0.14) and eating (0.52 +/- 0.10, P less than 0.001). In contrast, cold exposure caused a decrease in EF (0.43 +/- 0.13, P less than 0.05).

How can I increase my heart pumping? ›

7 powerful ways you can strengthen your heart
  1. Get moving. Your heart is a muscle and, as with any muscle, exercise is what strengthens it. ...
  2. Quit smoking. Quitting smoking is tough. ...
  3. Lose weight. ...
  4. Eat heart-healthy foods. ...
  5. Don't forget the chocolate. ...
  6. Don't overeat. ...
  7. Don't stress. ...
  8. Related Stories.
9 Feb 2017

Videos

1. How To Improve Ejection Fraction Of Your Heart | dr afzal cardiology
(Dr afzal cardiology Official)
2. Cardiomyopathy: Low Ejection Fractions
(The Valley Hospital)
3. Ejection fraction of heart II Pumping power of heart II ejection fraction की पुरी जानकारी हिंदी में
(Dr Nagendra Thalor MD medicine DM cardiology)
4. Treating LV Dysfunction - Improving EF and Heart Failure
(Abiomed)
5. HEART'S Pumping Improved from 15% to 35-40% | Heart Failure Treatment Review
(People Heart & Healthcare)
6. Estimating Ejection Fraction with Point of Care Echo
(Synthesis Med Ed)

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