Ultrasound heart ejection fraction normal

There is a calculation formula. To do this, the stroke volume is multiplied by the heart rate. So get the right amount. The result will indicate how much volume is pushed in one minute. In general, the normal rate should reach approximately 5,5 liters.

In medicine, they also use special programs that automatically calculate the fraction. For this, the Teicholz formula, the Simpson method, is used. Moreover, the data for these two calculations may differ by an average of 10%.

PV should be in the range of 50-60%, the norm according to Simpson suggests that the lower limit should not be less than 45%, and according to Teicholz 55%.

The Teicholz formula uses indicators of systolic and diastolic volume and size of the left ventricle. The study involved a small part of the latter.

The overall indicator of the length does not matter.

To get the PV index, the shortening volume is multiplied by a factor of 1,7. The OS is obtained from the formula ((KDD – KSD) / KDD) * 100%. Where KDD is the final diastolic diameter, KSD is the final systolic diameter.

Simpson’s formula is more modern, all significant myocardial zones are accurately shown here, taking into account the geometry of the ventricle and the presence of zones with impaired local contractility through the apical 4 and 2-chamber section.

Simpson’s method assumes the division of the cavity of the left ventricle into thin discs and the determination of their boundaries. The outlined systole and diastole are visible along the contour of the cardinal surface of the ventricle; according to these data, an estimate of the ejection volume can be made.

This indicator can be calculated by the formula of Teicholz or Simpson. The calculation is carried out using a program that automatically calculates the result depending on the final systolic and diastolic volume of the left ventricle, as well as its size.

Simpson’s calculation is considered to be more successful, since according to Teicholz small sections of the myocardium with impaired local contractility may not get into the section of the study with two-dimensional Echo-KG, while with the Simpson method, larger sections of the myocardium fall into the section of the circle.

Despite the fact that the Teicholz method is used on outdated equipment, modern ultrasound diagnostic cabinets prefer to evaluate the ejection fraction by the Simpson method. The results obtained, by the way, may differ – depending on the method, by values ​​within 10%.

How to treat a low level of fraction?

Doctors may alert patients to complaints of pain in the heart, chest pain, interruptions in heart function, palpitations, shortness of breath during physical exertion, dizziness, fainting, swelling in the legs, fatigue, decreased performance, and weakness. The first studies usually become an electrocardiogram and a biochemical blood test. Further, Holter monitoring of the electrocardiogram, bicycle ergometry and ultrasound of the heart can be performed.

With information about the rate of cardiac output, the reader can analyze the performance of the body. When the ejection of the left ventricle is below normal, it is recommended that you consult a cardiologist in a short time. It is worth noting that doctors are primarily interested not in the presence of pathology, but in the cause of the development of the disease. Therefore, after ultrasound, additional studies are often performed.

Low ventricular ejection is most often characterized by poor health, swelling, and shortness of breath. How to increase the volume of the fraction? We live in an era of advanced medicine, therefore, in the arsenal of doctors to increase the release of blood into the vessels, the first place is therapy. Basically, the ward is on outpatient treatment, during which experts observe the activities of the heart and vascular system. In addition to drug treatment, sometimes surgical intervention is performed.

Recommendations for low ejection fraction:

  • fluid intake is strictly regulated and amounts to 1,5-2 liters of water per day;
  • rejection of salt, seasonings and dishes containing it;
  • diet ration;
  • moderate physical activity;
  • taking medications: urinary tract stimulants, inhibitors, adrenaline blockers, digoxin, etc.

You can restore blood supply by the surgical method. As a rule, operations are prescribed to patients who have been diagnosed with severe heart or valve disease. Often, valves are resected and prostheses installed. This approach allows you to normalize heart rhythm, eliminate arrhythmia and fibrillation. It should be noted that operations are carried out if there is a high danger to human life. In all other cases, therapy is performed.

Let’s start the conversation with what the ejection fraction means. This term refers to a value that reflects the functioning of the heart muscle.

The indicator determines the amount of blood in the percentage that is pushed out by the left ventricle as a result of contraction. When calculating the indicator, the ratio of ejected blood relative to its amount, which is in the left ventricle at the time of relaxation, is determined.

This indicator is extremely important. Deviations from the normal level indicate serious problems in the work of the heart, which can cause the development of pathologies of the cardiovascular system and have a negative effect on the body. Therefore, it is necessary to diagnose and evaluate the ejection fraction.

If in the survey results the indicator is 60% or more, this indicates an overestimated level of the ejection fraction. The highest value can reach 80%, the greater amount of blood left ventricle to throw into the vessels is simply incapable due to its characteristics.

Cardiomyopathy or hypertension can trigger the development of myocardial hypertrophy. In such patients, the heart muscle can still cope with heart failure and compensates for it, trying to expel blood into a large circle of blood circulation. This can be judged by observing an increase in the PV of the left ventricle.

As heart failure progresses, the ejection fraction slowly decreases. For patients suffering from chronic heart failure, it is extremely important to undergo periodic echocardioscopy in order to observe a decrease in EF.

The ejection fraction is a parameter that demonstrates the amount of blood that the left ventricle expels into the aorta in the systolic phase. The ejection fraction is calculated by the proportion of the volume of blood pushed into the aorta and its volume in the left ventricle during the relaxation period.

This parameter is calculated quite simply. It clearly demonstrates the state of the ability of the muscular membrane of the heart to contract. The ejection fraction allows one to identify the need for a person to be treated with drugs and has prognostic value for people suffering from diseases of the cardiovascular system.

The closer to normal the value of the ejection fraction, the better the patient’s ability to contract in the myocardium, which indicates a more favorable prognosis of the disease.

Attention. If the calculated PV value is less than the average parameters, it should be concluded that the myocardium functions with difficulty and does not adequately supply the body with blood. In this case, the person needs to be prescribed cardiac medications.

In order to calculate the cardiac output fraction, the Teicholz or Simpson formula is used. The calculation is performed by a special program that automatically issues an assessment, taking into account information about the final systolic and diastolic LV volumes and its parameters.

Norms for adults

The indicators do not depend on the gender of the patient, therefore, in women and men, the norms are identical. However, they may vary by age. The older the person, the lower his norm.

If in adults the level is less than 35%, then this indicates that violations occur and the person is in danger. With hypertension, the indicator can increase, at the same time, in some people it can be extremely low, which is due to the physiological predisposition, but not less than 45%.

PV can be calculated by the formula: ((BWW – KSO) / BWW) * 100.

When a high fraction value is diagnosed

Low values ​​can be caused by pathologies such as:

  1. Coronary artery disease . In this case, the blood flow through the coronary arteries decreases.
  2. A history of myocardial infarction. This leads to the replacement of normal heart muscles with scars, which do not have the necessary ability to contract.
  3. Arrhythmia, tachycardia and other ailments that violate the rhythm of the main “motor” of the body and conduction.
  4. Cardiomyopathy It consists in an increase or lengthening of the heart muscle, which is due to hormonal failure, prolonged hypertension, heart defects.

The primary factor that provokes a failure of the ability of the muscle membrane of the heart to contract is the formation of chronic heart failure.

The following pathologies lead to a decrease in 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 deterioration of conductivity, rapid wear of the heart, and cardiomyopathy leads to an increase in muscle size.

Other diseases that reduce cardiac output:

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

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

The values ​​of the ejection fraction obtained by Doppler cardiography:

  • Normal rates 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% – “heart strength” is reduced. Normal values ​​are above 50%, “heart strength” is good. Allocate the “gray zone” from 40-50%.

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

Distinguish between symptomatic and asymptomatic, systolic and diastolic heart failure.

Heart failure is a syndrome that is formed due to a violation of the structure or functioning of the myocardium. Pathology of conduction or heart rhythm, inflammatory, immune, endocrine, metabolic, genetic, neoplastic processes, pregnancy can cause cardiac weakness with or without impaired ejection fraction.

– Coronary heart disease (more often after a heart attack);

– a combination of ischemic heart disease and hypertension;

– Valvular defects (rheumatic, sclerotic).

– systolic (ejection fraction of the heart – the norm is less than 40%);

– diastolic (ejection fraction of 45-50%).

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.).

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

– expansion of the jugular veins;

– crepitus in the lungs or pleural effusion;

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– Noises during auscultation of the heart, cardiomegaly.

The combination of several of the above symptoms, the availability of information about heart disease helps to establish heart failure, but it is crucial to conduct Doppler ultrasound of the heart with the determination of structural changes and assessment of the ejection fraction of the myocardium. In this case, the cardiac ejection fraction will be decisive, the norm after which myocardial infarction will be definitely different.

– ejection fraction of the heart – the norm is 45-50%;

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

– impaired relaxation or increased stiffness of the myocardium.

To exclude heart failure, biological markers have been determined in recent years: atrial natriuretic peptide (acute heart failure – more than 300 pg / ml, with chronic 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 concomitant pathologies, including arterial hypertension. In these patients, the level of natriuretic peptide type B in plasma is lower than in patients with a low fraction, but higher than in healthy ones.

Ultrasound examination of the heart

Echocardiographic examination of the cardiovascular system is a very important and also quite affordable diagnostic method. In some cases, the method is the “gold standard”, allowing you to verify a particular diagnosis. In addition, the method allows to detect latent heart failure, which does not manifest itself under intense physical exertion.

The indicator can be reduced with the following pathologies:

  • Myocardial infarction. When scars appear on the muscles and they cannot contract properly. Moreover, after a heart attack, it is not possible to increase the fraction by medication.
  • Coronary artery disease. In this case, the blood flow decreases.
  • Failure in rhythm of contractions. It leads to impaired conduction, heart wear.
  • Cardiomyopathy It causes an increase in muscle size.

This is due to the fact that the heart muscle begins to change, its layer grows, the structure of small blood vessels deteriorates, the fibers weaken, and the absorption of blood decreases.

In addition, the causes of pathology can be hidden in:

  • Angina pectoris
  • Hypertension.
  • Pericarditis, endocarditis, myocarditis.
  • Aneurysm of the walls of the ventricle.
  • Congenital malformations of an organ or blood vessel.
  • Vasculitis.

There are predisposing factors that can also disrupt the functioning of the body. These include obesity, tumors, severe intoxication, hormonal failure, and diabetes.

First, the patient is diagnosed in order to identify the pathology that caused the decrease. Next, the administration of drugs corresponding to the diagnosis is prescribed. With ischemia, the use of nitroglycerin is indicated, with hypertension, antihypertensive drugs and surgical correction of defects are prescribed.

In addition to treating the underlying disease, the contractile function of glycosides is stabilized. These include Digoxin, Korglikon, Strofantin.

So that the cardiovascular system is not overloaded with fluid, it is recommended that you follow a diet, reduce salt and daily fluid volume.

ATP inhibitors help strengthen blood vessels and thus protect the heart. When they are taken, tissue nutrition improves, the efficiency of the heart muscle and the resistance of the myocardium to load increase. This group includes: Enalapril, Perindopril, Captopril.

Beta-adrenergic blocking agents help reduce the body’s oxygen and nutritional requirements, increase the volume of myocardial contraction sites, and reduce cell death and heart rate. Their list includes: Nebivolol, Metoprolol, Bisoprolol.

Aldosterone receptor antagonists stabilize the electrolyte blood level, remove excess fluid, reduce the load on the myocardium.

Representatives of the group are Spironolactone, Eplerenone. Angiotensin 2 receptor antagonists have a similar effect, but they are somewhat stronger. Assign Valsartan, Candesartan, Olmesartan.

When the ejection fraction is low, statins can be used as adjunctive therapy to lower cholesterol and protect blood vessels. Apply Pravastatin, Fluvastatin, Simvastatin.

An increase in the indicator is rare, since physiologically this is impossible. The heart cannot expel blood more than it should be. Therefore, the level of 80% can occur in a child at an early age, athletes and patients leading an active lifestyle.

Sometimes the increase indicates myocardial hypertrophy, when the left ventricle seeks to compensate for the onset of CHF and pushes blood with considerable force.

If the indicators do not correspond to the norm, it is necessary to consult with a cardiologist and undergo an echocardioscopy to prevent the development of pathologies.

The primary factor that provokes a failure of the ability of the muscle membrane of the heart to contract is the formation of chronic heart failure.

The following pathologies become the main factors for the formation of this common disease:

  • coronary heart disease – reduced blood flow through the coronary vessels, providing oxygen to the heart muscle fibers;
  • myocardial infarction in the history of the disease, in particular – transmural and with an extensive lesion, in addition – repeated. This pathology causes the replacement of normal cardiomyocytes with connective tissue cells, with a lack of ability to contract;
  • prolonged or often developing malfunctions of the heart rhythm and conduction, this causes the myocardium to wear due to uneven and irregular pulses. This phenomenon is characteristic of a constant type of atrial fibrillation, often occurring attacks of ventricular extrasystole and increased heart rate, etc .;
  • cardiomyopathies – a disturbed structure of the heart, which is caused by an increase or extension of the myocardium, developing due to hormonal imbalance, a prolonged course of hypertension, characterized by high blood pressure, cardiological defects, etc.

3 Symptoms of the disease

The diagnosis of “reduced ejection fraction” can be made based on the symptoms characteristic of the disease. Such patients often complain of shortness of breath attacks, both during physical exertion and at rest. Dyspnea can provoke prolonged walking, as well as performing simple household chores: mopping, cooking.

The low ejection fraction responds to various changes in the body. Symptoms are extensive and varied, determined by the root cause, the presence of concomitant diseases, the age of the patient, and many other factors. The following symptoms are most common, the presence of which indicates the nature of the problem:

  • fatigue, which is permanent;
  • fluid accumulation in the abdominal cavity and chest;
  • decreased physical capabilities of the body;
  • difficulty breathing and a constant feeling of lack of air, which increases with the horizontal position of the body;
  • frequent dizziness, which can lead to fainting;
  • decreased vision;
  • pain in the area of ​​the heart muscle;
  • swelling in the legs;
  • an increase in the size of the liver;
  • weight reduction that occurs in a short time;
  • impaired coordination of movements, loss in space and decreased sensitivity in the arms and legs;
  • stool disorders, abdominal pain, nausea and blood vomit;
  • the presence of blood in the stool.

A fall in heart contractility is caused by heart failure. In this case, the following symptoms are observed:

  • development of dyspnea at rest, during physical exertion, in a supine position (especially during night sleep);
  • a gradual decrease in the intensity of the loads for the appearance of shortness of breath (in severe cases, the simplest manipulations – cooking, walking around the room can provoke attacks);
  • general weakness, malaise, fatigue, dizziness, episodes of loss of consciousness are possible;
  • swelling of the body, face, lower leg and foot, the development of anasarca (accumulation of fluid in the internal organs and cavities);
  • soreness of the right half of the abdomen, an increase in its volume.

Without the proper adequate and timely treatment, a violation of the systolic work of the heart progresses, grows and can disrupt the normal existence of a person. A decrease in heart performance is a consequence of the disease. Therefore, before therapy it is important to determine the cause of the pathology.

For example, with ischemic heart disease, Nitroglycerin is prescribed, defects are removed in an operative way, hypertension is stopped by taking antihypertensive drugs. The patient should clearly understand that a violation of the pumping function of the heart indicates a deterioration in his condition, the development of heart failure, which has dangerous consequences and complications.

A low ejection fraction indicates serious cardiac abnormalities. Having received the diagnosis, the patient needs to reconsider his lifestyle, to eliminate excessive stress on the heart. Deterioration can cause emotional distress.

Low ejection fraction

Ultrasound examination of the heart, as well as radiopaque or isotopic ventriculography, will help to obtain information about the ejection fraction of the left and right ventricles. Ultrasound examination is the cheapest, safest and not burdensome for the patient. Even the simplest ultrasound machines can provide an idea of ​​the cardiac output fraction.

Now that you know the standards for the ejection fraction, you can evaluate how your heart works. If the fraction of cardiac output of the left ventricle by echocardiography is below normal, you will need to see a doctor immediately. For a cardiologist, it is important not only to find out that heart failure exists, but also to find out the cause of this condition.

Therefore, after an ultrasound examination, other types of diagnostics can be carried out. A low ejection fraction can be a predisposing factor for poor health, swelling, and shortness of breath. Currently, the cardiologist’s arsenal has treatments for diseases that cause a low ejection fraction.

The main thing is the constant outpatient monitoring of the patient. In many cities, specialized cardiological dispensaries are organized for free dynamic monitoring of patients with heart failure. A cardiologist may prescribe conservative treatment with pills or surgical procedures.

An increasingly important role is played by surgical treatment of a reduced fraction of cardiac output. Operations have been developed to restore blood flow in the coronary vessels in coronary heart disease. Surgery is also used to treat severe valvular heart disease. According to indications, artificial heart rate drivers can be installed to prevent arrhythmia in the patient and eliminate fibrillation.

The ejection fraction is an indicator that determines the efficiency of the muscles of the heart organ at the time of impact. It is measured as a percentage of the volume of blood entering the vessels in the state of ventricular systole. For example, in the presence of 100 ml, 65 ml enters the vascular system, so the cardiac output will be 65%.

The ejection fraction is not assigned to all patients, but only to those who complain about:

  • pain in the chest;
  • systematic interruptions in the work of the body;
  • tachycardia;
  • dyspnea;
  • frequent dizziness and fainting;
  • swelling of the lower extremities;
  • fatigue and weakness;
  • decrease in productivity.

As a rule, the first study is an electrocardiogram and ultrasound. These examinations make it possible to determine the extent to which cardiac output of both the left ventricle and the right ventricle occurs. Diagnostics are notable for their low price, high information content, and there is no specific preparation. The availability of the procedure is due to the fact that any ultrasound equipment is able to provide data on the fraction.

If the doctor has a suspicion of a malfunction of the heart, he directs the patient to make a cardiogram and a biochemical blood test. Holter monitoring, an electrocardiogram, bicycle ergometry and ultrasound examination of the organ can also be performed.

Doctors study all the indicators at once and, by their total value, already judge the presence of pathology. The main ones are:

  • Cardiac output should be between 55 and 60%.
  • The magnitude of the right-chamber atrium is 2,7-4,6 cm.
  • The diameter of the aorta is 2,1-4,2 cm.
  • The size of the left atrium is 1,8-4 cm.
  • The norm of the stroke volume is 60-100 cm.
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When the indicator is in the range of 55-75%, this is the norm. The value is reduced from 45 to 55%. When it is up to 45, it means that the patient has heart failure. If below 35%, then irreversible disturbances in the work of the organ occur and a person needs urgent treatment.

The main symptom, when the fraction is reduced, is the appearance of shortness of breath, and regardless of the load. It can appear even due to insignificant loads when doing homework. Sometimes shortness of breath can be at night or in a supine position.

Of the other signs, patients note:

  • Increased weakness, fatigue and dizziness, up to loss of consciousness. This is due to a lack of blood flow and, as a consequence, oxygen starvation.
  • The appearance of edema. This is due to fluid stagnation.
  • Severe pain in the right side of the abdomen. This is noted due to congestion in the vessels of the liver, which can provoke further cirrhosis.
  • Visual impairment.
  • Pain in the area of ​​the heart with an increase in the rhythm of contractions.
  • Decreased limb sensitivity.
  • Coordination violation.
  • Nausea, vomiting.

Symptoms indicating a deterioration in contractility of the heart muscle are caused by chronic heart failure. Therefore, it is paramount to pay attention to the signs that have arisen.

The following signs indicate a failure of the ability of the heart muscle to contract:

  • Dyspnea in normal condition or during physical exertion, in a supine position at night.
  • Attacks of dyspnea can bother even when performing simple actions – walking, cooking, changing clothes.
  • Weakness, high fatigue, dizziness up to loss of consciousness – these phenomena signal the oxygen starvation of the brain.
  • Edema in the facial area, on the legs, sometimes even inside the body or throughout the body, which is caused by damage to the blood flow in the vasculature under the skin, where excess fluid accumulates.
  • Pain in the right half of the body, an enlarged abdomen due to accumulated excess fluid in the abdominal cavity, which indicates the accumulation of blood in the veins of the liver, and prolonged stagnation can cause liver cirrhosis of cardiological origin.

The normal value of the ejection fraction differs in different people, and also depends on the equipment on which the study is conducted, and on the method by which the fraction is calculated.

Of deviations from the norm, more often than an increased ejection fraction, there is a decrease in its value due to various diseases.

If the indicator is lowered, it means that the heart muscle cannot contract sufficiently, as a result of which the volume of expelled blood decreases, and the internal organs, and, first of all, the brain, receive less oxygen.

Sometimes, in the conclusion of echocardioscopy, you can see that the PV value is higher than the averaged indicators (60% or more). As a rule, in such cases, the indicator is not more than 80%, since the left ventricle, due to physiological characteristics, cannot be able to expel a larger amount of blood into the aorta.

As a rule, high PV is observed in healthy individuals in the absence of a different cardiological pathology, as well as in athletes with a trained heart muscle, when the heart contracts with each beat with greater force than in an ordinary person, and expels a larger percentage of the blood contained in it.

In addition, if the patient has LV myocardial hypertrophy as a manifestation of hypertrophic cardiomyopathy or arterial hypertension, increased PV may indicate that the heart muscle can still compensate for the onset of heart failure and seeks to expel as much blood as possible into the aorta.

All symptoms by which a decrease in contractile function of the heart can be suspected are due to heart failure. Therefore, the symptoms of this disease come first.

However, according to the observations of ultrasound diagnostics practitioners, the following is often observed – in patients with severe CHF, the ejection fraction indicator remains within the normal range, while in individuals with no obvious symptoms, the ejection fraction indicator is significantly reduced. Therefore, despite the absence of symptoms, patients with cardiac abnormalities must undergo echocardioscopy at least once a year.

So, the symptoms that make it possible to suspect a violation of myocardial contractility include:

  1. Attacks of shortness of breath at rest or during physical exertion, as well as lying down, especially at night,
  2. The load provoking the occurrence of shortness of breath can vary from significant, for example, walking on long distances (more than 500-1000 m), to minimal household activity, when it is difficult for the patient to perform simple manipulations – cooking, tying shoelaces, walking to the next room etc,
  3. Weakness, fatigue, dizziness, sometimes loss of consciousness – all this indicates that the skeletal muscles and the brain receive little blood,
  4. Swelling on the face, legs and feet, and in severe cases – in the internal cavities of the body and throughout the body (anasarca) due to impaired blood circulation through the vessels of the subcutaneous fat, in which flu >

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

However, treatment methods for a heart pathology with a normal fraction have not been determined; 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, the norm, its pathology, require a serious approach to the problem.

Visualize the heart muscle and determine the work of the chambers of the heart (atria, ventricles) using Doppler cardiography. To understand how the heart works, examine its ability to contract (systolic function) and relaxation (diastolic function) of the myocardium.

Relevance of the problem

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

According to European studies (echocardiography), 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 both them and the state. Therefore, the search for ways to prevent the occurrence, early diagnosis and effective treatment of heart diseases remains relevant.

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

  • adenosine converting enzyme inhibitors (Enalapril);
  • angiotensin P antagonists (Valsartan);
  • beta blockers (Carvedilol);
  • aldosterone blockers (“Spironolactone”);
  • diuretics (“Torasemide”);
  • “Digoxin”.

Home remedies

Basically, this therapy is aimed at eliminating symptoms and maintaining the performance of organs. So, to prevent swelling, take decoctions of calendula, milk thistle, horsetail, yarrow, knotweed, nettle, chicory, birch buds, juniper berries, rose hips, lingonberries. They need to be drunk at intervals when similar drugs are canceled.

  1. Effective is considered a decoction of grass mistletoe, hawthorn and dried cinnamon, taken in equal quantities. Two tablespoons of the mixture is poured with a liter of boiling water and put on a small fire. After a couple of minutes, the brew is set aside and insisted for about half an hour. Having stretched, take 125 ml three times a day.
  2. The dried fruits of hawthorn in the amount of 6 tablespoons are ground and added to the motherwort herb in the same amount. After pouring a mixture of 1,5 liters of boiling water, insist a day, wrapping it well. Then it is filtered and placed in the refrigerator. You need to drink three times a day for half an hour before meals, one glass.
  3. In the treatment of cardiac pathologies, hawthorn is often used. It helps to normalize heart rate, reduce hypertension, chest pain, and fights against atherosclerosis and heart failure. Hawthorn flowers and berries help the heart, increasing its ability to pump blood. This plant helps reduce shortness of breath and fatigue. Hawthorn can be used both as a tincture and as a decoction.

To thin the blood, willow bark, meadow clover, clover, meadowsweet, hawthorn, rakita are used.

To sedative fees include:

  • Composition of hawthorn, cinnamon, chamomile, caraway and motherwort.
  • A decoction of St. John’s wort, mistletoe, sage, yarrow, dried calendula, calendula, horsetail and pine buds.

When is treatment for a reduced ejection fraction required?

Step 1: diuretic (“Torasemide”) an angiotensin-converting enzyme inhibitor (“Enalapril”) or an angiotensin P receptor blocker (“Valsartan”) with a gradual increase in the dose to a stable state beta-blocker (“Carvedilol”).

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

If symptoms persist, it is possible to add “Digoxin”, “Hydralazine”, nitrorepates (“Cardiket”) to the treatment and / or perform invasive interventions (installation of resynchronization devices, implantation of a cardioverter-defibrillator, heart transplantation), after having 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 for treating heart failure with angiotensin-converting enzyme inhibitors, angiotensin P receptor blockers, beta-blockers, aldosterone blockers, diuretics, nitrates, hydralazine, digoxin, omacor, if necessary, the installation of resynchronization devices and cardioverter-defibrillators has significantly increased the last two decades patients with terminal forms of this disease. This poses new challenges for doctors and researchers.

The search for methods to replace myocardial scar tissue remains relevant.

Before prescribing the necessary therapy for detecting a decreased FV of the heart, the cause that became the factor for its reduction should be determined.

The treatment for this condition is completely diverse – from medication to surgery.

In addition to drugs that affect the pathology that caused a decrease in EF, the patient is prescribed medications to help correct the contractility of the muscular heart membrane.

Prevention against the negative effects on the heart of excess fluid is a commitment to diet, which is to reduce salt intake to one and a half grams per day.

In addition, the patient must reduce the amount of fluid consumed to one and a half liters maximum per day. Taking diuretics is a good result – diuretics (“Eufillin”, “Mannitol”, “Furosemide”, “Indacrinone”, “Diacarb”, “Demeclocycline” and others.)

To protect the heart and vascular system from the inside, doctors prescribe the use of special medicines with a protective effect of angiotensin-converting enzyme inhibitors.

The therapeutic plan is selected based on the individual characteristics of the patient. The patient needs to prepare for the fact that the ejection fraction of the heart does not come to good indicators immediately, and the symptoms can persist for a certain period of time after the start of drug therapy.

In some situations, the only way to get rid of a disease that has become a factor in the development of chronic heart failure is through surgery. In particular, the following operations are applied:

  • heart valve implantation
  • by inserting stents or shunts on coronary arteries,
  • on the implantation of an artificial electric pacemaker and others.

It is worth considering that in the presence of a severe degree of heart failure (3-4), accompanied by a greatly reduced ejection fraction, surgery is not used due to the possibility of developing serious consequences.

  • Coronary heart disease – a decrease in blood flow through the coronary arteries, supplying oxygen to the heart muscle itself,
  • Myocardial infarction, especially large focal and transmural (extensive), as well as repeated ones, as a result of which normal muscle cells of the heart after a heart attack are replaced by scar tissue that does not have the ability to contract – post-infarction cardiosclerosis is formed (in the description of the ECG, you can see the abbreviation PIKS),
  • Long-existing or frequent acute occurring disturbances in heart rhythm and conduction, leading to gradual wear of the muscle due to its irregular and irregular contractions, for example, a constant form of atrial fibrillation, frequent attacks of ventricular extrasystole and tachycardia, etc.
  • Cardiomyopathies are structural disturbances in the configuration of the heart caused by hypertrophy (enlargement) or extension (dialysis) of the heart muscle, resulting from hormonal imbalances in the body, long-term arterial hypertension with high numbers of blood pressure, heart defects, etc.

Of course, no doctor will offer you to treat a low rate obtained by ultrasound of the heart. First, the doctor must identify the cause of the reduced EF, and then prescribe a treatment for the causative disease. Depending on it, the treatment may differ, for example, taking nitroglycerin preparations for ischemic disease, surgical correction of heart defects, antihypertensive drugs for hypertension, etc.

In addition to drugs that affect the causative disease, the patient is prescribed medications that can improve myocardial contractility. These include cardiac glycosides (digoxin, strophanthin, korglikon). However, they are prescribed by a strictly attending physician and their independent uncontrolled use is unacceptable, since poisoning can occur – glycosidic intoxication.

To prevent overloading the heart with a volume, that is, excess fluid, a diet is shown with a restriction of sodium chloride to 1.5 g per day and with a restriction of drinking fluid to 1.5 l per day. Diuretics (diuretics) – diacarb, diuver, veroshpiron, indapamide, torasemide, etc. are also successfully used.

To protect the heart and blood vessels from the inside, drugs with the so-called organoprotective properties are used – ACE inhibitors. These include enalapril (Enap, Enam), perindopril (prestarium, prestanz), lisinopril, captopril (Kapoten). ARA II inhibitors, such as losartan (Lorista, Lozap), valsartan (Valz), etc., are also widely distributed among drugs with similar properties.

The treatment regimen is always selected individually, but the patient should be prepared for the fact that the ejection fraction does not normalize immediately, and the symptoms may be disturbing for some time after the start of therapy.

However, in case of severe heart failure (functional class III-IV) with an extremely low ejection fraction, surgery may be contraindicated. For example, a contraindication to mitral valve replacement is a decrease in EF less than 20%, and for implantation of a pacemaker – less than 35%. Nevertheless, contraindications to operations are revealed at face-to-face examination at the cardiac surgeon.


Thus, from the presented article, one can see the practical value of the methods undertaken by doctors. The ejection fraction (norm and pathology) has not yet been fully studied. And although medicine is currently not yet perfect for combating the pathologies under consideration, we need to hope and invest a sufficient amount of investment in the development and development of scientific research in this area.

Having suggested using the ultrasound method to visualize human organs in the 1950s, Inge Elder was not mistaken. Today, this method plays an important and sometimes key role in the diagnosis of heart disease. Let’s talk about the decoding of its indicators.

Health forecast

The prognosis depends on how low the patient is diagnosed. With a decrease in the value to 40-45%, the risk of cardiac arrest is small, about 10-15%. When the PV decreases to 34-39%, then the possibility of death is in the range of 20-25%.

If this indicator becomes even lower, then the life threat to the patient increases as the PV decreases.

The ejection fraction provides information on the health of the left ventricle. In men and women, the norm is the same (55-70%), but in children the rate can reach 70-80%, which is not considered a pathology.

The most common low fraction. To raise the indicator, it is necessary to find the cause of the pathology and organize adequate treatment. If this is not done, the patient is at risk of developing heart failure, death.

Causes of reduced heart ejection fraction

The size of the chambers of the heart is a parameter that is determined in order to exclude or confirm overload of the atria or ventricles.

Left atrium. The norm of the diameter of the left atrium (LP) in mm for men is ≤ 40, for women ≤ 38. An increase in the diameter of the left atrium may indicate a heart failure in the patient. In addition to the diameter of the drug, its volume is also measured. The norm of the LP volume for men in mm3 is ≤ 58, for women ≤ 52. The size of the LP increases with cardiomyopathies, mitral valve defects, arrhythmias (cardiac arrhythmias), and congenital heart defects.

Right atrium. For the right atrium (PP), as well as for the left atrium, the sizes (diameter and volume) are determined by echocardiography. Normally, the diameter of the PP is ≤ 44 mm. The volume of the right atrium is divided by the surface area of ​​the body (PPT). For men, the ratio of PP / PPT ≤ 39 ml / m2 is considered normal, for women – ≤33 ml / m2.

ECHO Cardiography (ultrasound of the heart)

Left ventricle. For the ventricles introduced their own parameters regarding their size. Since the practitioner is interested in the functional state of the ventricles in systole and diastole, there are corresponding indicators. The main size indicators for LV:

  1. Diastolic size in mm (men) – ≤ 58, women – ≤ 52;
  2. Diastolic size / PPT (men) – ≤ 30 mm / m2, women – ≤ 31 mm / m2;
  3. Final diastolic volume (men) – ≤ 150 ml, women – ≤ 106 ml;
  4. Final diastolic volume / PPT (men) – ≤ 74 ml / m2, women – ≤61 ml / m2;
  5. Systolic size in mm (men) – ≤ 40, women – ≤ 35;
  6. The final systolic volume (men) – ≤ 61 ml, women – ≤ 42 ml;
  7. Final systolic volume / PPT (men) – ≤ 31 ml / m2, women – ≤ 24 ml / m2;

Right ventricle. Basal diameter – ≤ 41 mm; Final diastolic volume (BWW) RV / PPT (men) ≤ 87 ml / m2, women ≤ 74 ml / m2; The final systolic volume (CSR) of RV / PPT (men) – ≤ 44 ml / m2, women – 36 ml / m2; Pancreatic wall thickness – ≤ 5 mm.

Interventricular septum. The thickness of the MJP in men in mm – ≤ 10, in women – ≤ 9;

Diseases of the cardiovascular system in civilized countries are the first cause of death of the majority of the population. In Russia, coronary heart disease and other diseases of the circulatory system are extremely widespread.

after 40 years, the risk of getting sick becomes especially high. Risk factors for cardiovascular problems are male gender, smoking, a sedentary lifestyle, carbohydrate metabolism disorders, high cholesterol, high blood pressure and some others. In the event that you have several risk factors or complaints from the cardiovascular system, then you should seek medical attention from a general practitioner or cardiologist for examination.

The ejection fraction is an indicator that determines what effective work the heart performs with each beat. The ejection fraction is called the percentage of the volume of blood ejected into the vessels from the ventricle of the heart during each contraction. If there was 100 ml of blood in the ventricle, and after heart contraction, 60 ml fell into the aorta, then we can say that the ejection fraction was 60%.

When you hear the term “ejection fraction”, it usually refers to the function of the left ventricle of the heart. Blood from the left ventricle enters a large circle of blood circulation. It is left ventricular failure that leads to the development of the clinical picture of heart failure most often. The ejection fraction of the right ventricle can also be fully assessed by ultrasound of the heart.

Diseases of the cardiovascular system in civilized countries are the first cause of death of the majority of the population. In Russia, coronary heart disease and other diseases of the circulatory system are extremely widespread. After 40 years, the risk of getting sick becomes especially high. Risk factors for cardiovascular problems are male gender, smoking, a sedentary lifestyle, carbohydrate metabolism disorders, high cholesterol, high blood pressure and some others.

In the event that you have several risk factors or complaints from the cardiovascular system, then you should seek medical attention from a general practitioner or cardiologist for examination. Using special equipment, the doctor will determine the size of the left ventricular ejection fraction and other parameters, and, therefore, the presence of heart failure.

The ejection fraction is an indicator that determines what effective work the heart performs with each beat. The ejection fraction is called the percentage of the volume of blood ejected into the vessels from the ventricle of the heart during each contraction. If there was 100 ml of blood in the ventricle, and after heart contraction, 60 ml fell into the aorta, then we can say that the ejection fraction was 60%.

When you hear the term “ejection fraction”, it usually refers to the function of the left ventricle of the heart. Blood from the left ventricle enters a large circle of blood circulation. It is left ventricular failure that leads to the development of the clinical picture of heart failure most often. The ejection fraction of the right ventricle can also be fully assessed by ultrasound of the heart.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.