Patient education: Heart failure with reduced ejection fraction (The Basics)

What is heart failure with reduced ejection fraction? — This is a type of heart failure. Heart failure is a condition in which the heart does not pump or fill with blood well. As a result, the heart lags behind in its job of moving blood throughout the body. This can lead to symptoms such as swelling, trouble breathing, and feeling tired.

There are 2 main types of heart failure:

●In heart failure with reduced ejection fraction, the heart is too weak. When the heart pumps, it doesn't squeeze normally. This type of heart failure is also known as "systolic heart failure."

●In heart failure with preserved ejection fraction, the heart is too stiff. When the heart pumps, it doesn't relax and fill with blood normally. This type of heart failure is also known as "diastolic heart failure."

The "ejection fraction" (or "EF") is the amount of blood that the heart pumps out with each heartbeat. People with "heart failure with reduced ejection fraction" have an EF that is lower than normal. People with the other type of heart failure, "heart failure with preserved ejection fraction," have a normal (or almost normal) EF.

What are the symptoms of heart failure with reduced ejection fraction? — Symptoms can include:

●Trouble breathing – At first, people might have trouble breathing only with activity. Over time, they can also have trouble breathing when resting or lying down.

●Swelling in the feet, ankles, legs, or belly

●Feeling tired

Is there a test for heart failure? — Yes. If your doctor or nurse thinks you might have any type of heart failure, they will ask about your symptoms, do an exam, and order some of the following tests:

●Chest X-ray – This test can show if there is fluid in the lungs. It also shows the general shape of the heart and large blood vessels in the chest.

●Electrocardiogram (also called "ECG") – This test measures the electrical activity in the heart.

●BNP or NT-proBNP – Brain natriuretic peptide (also called BNP) and N-terminal pro-BNP (also called NT-proBNP) are blood tests that help show if heart failure is present.

●Echocardiogram (also called an "echo") – This test uses sound waves to create a picture of the heart as it beats.

●Stress test – During this test, a doctor records your ECG while you exercise on a treadmill or bike, or get medicine to make your heart pump faster.

●Cardiac catheterization (also called "cardiac cath") – During this test, the doctor puts a thin tube into a blood vessel in your leg or arm. Then they move the tube up to your heart. When the tube is in your heart or blood vessels, they will take blood pressure measurements. The doctor might also put a dye that shows up on an X-ray into the tube. This can show if any arteries in your heart are narrowed or blocked. This part of the test is called "coronary angiography."

How is heart failure with reduced ejection fraction treated? — Treatment usually includes:

●Taking medicines – Medicines can help reduce symptoms and help you live longer. They might also lower the chance that you will need to go to the hospital. Many people need to take 3 or more medicines every day. It's important to take your medicines every day, even if you feel well. Tell your doctor or nurse if you can't afford your medicines or if they cause side effects. There are often ways to help with these issues. The right medicines for you will depend on your symptoms and other medical conditions, and can include:

•An angiotensin converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), or angiotensin receptor-neprilysin inhibitor (ARNI) – An ACE inhibitor, ARB, or ARNI widens blood vessels and lowers blood pressure, making it easier for your heart to pump. These medicines might also protect the heart from hormone effects that can happen when a person has heart failure. If you can't take an ACE inhibitor, your doctor might prescribe an ARB or other medicine. The ARNI sacubitril-valsartan is a newer heart failure medicine that can be used instead of an ACE inhibitor.

•A beta blocker – This medicine can slow the heart rate down and sometimes lowers blood pressure. It can reduce the amount of work the heart has to do. When you start taking a beta blocker, you might feel a little worse. But after your body gets used to the medicine, you might start to feel better.

Ivabradine (brand name: Corlanor) is a newer type of medicine to slow the heart down. Your doctor might prescribe ivabradine if your heart rate is still a little fast with a beta blocker, or if you cannot take a beta blocker.

•A diuretic (water pill) – This medicine helps the body get rid of extra salt and fluid. It can reduce the fluid in your lungs or swelling in your legs or belly.

•A mineralocorticoid receptor antagonist – This helps the body get rid of extra salt and fluid. But it also helps the body hold onto a mineral called potassium. That is important, because the body needs potassium to work normally. Other diuretics sometimes make the body lose potassium. A mineralocorticoid receptor antagonist also protects your heart from harmful hormone effects that happen in heart failure.

•An SGLT2 inhibitor – These medicines are used to treat people with diabetes. They can also be used to treat heart failure with reduced EF even if you do not have diabetes.

•Nitrate with hydralazine – A nitrate and hydralazine work together to relax and expand blood vessels. This makes it easier for the heart to pump blood throughout the body. These 2 medicines come in a single pill, but it is possible to get the 2 ingredients separately for much less money. The 2 ingredients come in pills of "isosorbide dinitrate" and "hydralazine."

●Digoxin – Digoxin helps the heart pump with more force. This can help reduce some of the symptoms of heart failure.

●Treating your coronary heart disease (if you have it) – In coronary heart disease, the arteries that bring blood to the heart get clogged. Treatment can include medicines, a procedure to unblock a clogged artery, or surgery.

Other treatment for heart failure with reduced EF sometimes includes:

●A device to help the heart pump with more force or beat at the right rhythm

●A pump attached to the heart to increase blood flow to the body and reduce the work the heart needs to do

●Heart transplant surgery – This is surgery to replace your diseased heart with a healthy heart. It is done only when all other treatments do not work.

What else can I do on my own to protect my heart? — To help feel better and reduce the chances that you will need to go to the hospital, you can do the following:

●Call your doctor or nurse if you are dizzy or weak, or if you lose or gain weight suddenly. Weigh yourself every morning after you urinate but before breakfast. Try to wear about the same amount of clothing every time.

●Follow the action plan your doctor gives you. An action plan is a list of instructions that tells you what to do if your symptoms change. To use an action plan, watch your symptoms closely and weigh yourself every day. If you do not feel well or if you lose or gain weight suddenly, look at your action plan to see what to do (figure 1 and figure 2).

●Call for an ambulance (in the US and Canada, call 9-1-1) if you have chest pain or other signs of a heart attack (figure 3)

●Lose weight, if you are overweight

●Stop smoking

●Limit the amount of alcohol you drink. For females, this means no more than 1 drink a day. For males, it means no more than 2 drinks in a day.

More on this topic

Patient education: Medicines for heart failure with reduced ejection fraction (The Basics)
Patient education: Heart failure (The Basics)
Patient education: Heart failure with preserved ejection fraction (The Basics)
Patient education: Swelling (The Basics)
Patient education: Shortness of breath (dyspnea) (The Basics)
Patient education: Echocardiogram (The Basics)
Patient education: ECG and stress test (The Basics)
Patient education: Cardiac catheterization (The Basics)
Patient education: Coping with high drug prices (The Basics)
Patient education: Coronary artery disease (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Cardiac resynchronization therapy (The Basics)
Patient education: Heart transplant (The Basics)

Patient education: Edema (swelling) (Beyond the Basics)
Patient education: Shortness of breath (dyspnea) (Beyond the Basics)
Patient education: Heart failure (Beyond the Basics)
Patient education: Heart attack (Beyond the Basics)
Patient education: Heart transplantation (Beyond the Basics)