How to increase the ejection fraction of the heart using folk remedies. Assessment of ventricular function of the heart. Left ventricular ejection fraction

Reduced values impact indicators(eg, volume, work, strength and their indices adjusted for body surface area) are often associated with reduced myocardial contractility, but since these parameters are significantly dependent on pre- and afterload, these two variables also need to be determined. The dependence of stroke volume on preload was described more than 100 years ago by Otto Frank and E.N. Starling (since then it has been called the Frank-Starling mechanism). Based on the relationship between preload and SV or systolic work, a ventricular function curve can be constructed using systolic work values at different levels of preload, which can be expressed as ventricular EDV, EDV, or end-diastolic wall stress.
On preload may be affected by volume loading (elevating the legs, infusing large volumes of fluid) or reducing it (occlusion with a balloon catheter of the vena cava).

LV afterload can be calculated from mean or end-systolic arterial or ventricular pressure or, more accurately, by calculating mean systolic, peak systolic and end-systolic wall stress. The most reliable method for determining LV contractility is to determine the pressure-to-volume ratio at end-systole (PSV/CVR; maximum elasticity), because this indicator is almost independent of pre- and afterload.

Slope of a given line ratio denotes LV contractility. The use of ventricular function curves in assessment is limited by the technical difficulties of making measurements in patients, changes that occur during the time required to take measurements, and varying interpretation because interpretation depends on the patient's sex, age, and afterload. Changes in RV DN may affect position interventricular septum(IVS) and change LV diastolic pressure, thereby changing the position of the ventricular function curve.

Left ventricular ejection fraction

There are several indexes global systolic function and LV contractility. Each index depends to some extent on pre- and afterload and can vary depending on the volume of the ventricle and myocardial mass. Important feature their use in clinical practice is ease of use.

Ejection fraction- this is the ratio of MA to KDO. In most cases, it is calculated by the formula: EF = (EDV - ESV) / EDV x 100 (%), where EF is the ejection fraction, EDV is the end-diastolic volume, ESV is the end-systolic volume.

Normal LVEF value- 55-75% with cine angiography and echocardiography, but may be lower when determined by radionuclide angiography (45-65%). There are no gender differences observed. However, with age there is a tendency for EF to decrease. A sharp increase in afterload, as with sharp increase pressure load, leads to a decrease in EF to 45-50% in healthy people. However, the decrease in LVEF< 45% свидетельствует об ограниченной функции миокарда, независимо от условий нагрузки.

Wide application of PV in clinical practice is the result of a number of factors: ease of calculation, reproducibility using in various ways imaging and extensive literature evidence supporting its clinical benefit. This indicator has important prognostic value (both short- and long-term) in patients with various CVDs. However, it has its limitations, since it depends not only on myocardial contractility, but also on pre- and afterload, as well as on heart rate and contraction synchrony. This parameter is also global, and regional differences in contractility appear to be averaged.

What is cardiac ejection fraction?

FVS is an indicator that is calculated using a special formula. The stroke volume of blood that enters the aorta after one contraction of the heart muscle is taken and its ratio is determined in accordance with the end-diastolic volume of the ventricle - the blood accumulated in the cavity during the period of relaxation.

The resulting value is multiplied by one hundred percent, which makes it possible to obtain the final result. It is the percentage of blood that is pushed into the ventricle during systole according to the total volume of fluid it contains.

The calculation of the indicator is carried out using computer technology during ultrasonographic examination of the heart chambers. With this diagnostic method Only the left ventricle is examined.

Ultrasonography makes it possible to determine the ability of the left ventricle to perform its functions, which are to ensure adequate blood flow in the body.

Video about what cardiac ejection fraction is.

Values: norm, deviations

If a person is at physiological rest, then the normal value of EF is a percentage. Significant physical activity in adults leads to an increase in the percentage. No further increase is observed. This is explained by the fact that the myocardium cannot eject all the blood from the ventricle, as this causes cardiac arrest.

Values: norm, deviations

IN modern medicine Only the reduced indicator is assessed. This is the main criterion that allows us to determine the irrational functioning of an organ. When the indicator decreases, most patients are diagnosed with myocardial contractile failure. In this case, the fraction value is less than 45 percent.

Contractile insufficiency poses risks not only to health, but also to human life. When there is insufficient blood supply to organs, their functioning is disrupted. Against this background, multiple organ dysfunction develops, which leads to death.

Reduced ejection volume is most often observed against the background of systolic failure. It is completely impossible to get rid of this pathological condition. If certain conditions occur, treatment is performed by an endovascular or vascular surgeon. A person’s gender has no influence on EF. In elderly patients, a physiological decrease in indicators occurs.

When EF decreases, we can talk about an individual norm. But, with a value of less than 45 percent, a pathological process is diagnosed. In a healthy person, the EF value may increase if the heart rate and level of blood pressure. If radionucleide angiography is used to measure the indicator, then the norm is percent.

If a patient is diagnosed with an indicator of less than 35 percent, this indicates the occurrence of irreversible processes in the myocardium. In the first few years of a child’s life, EF standards are higher and amount to 100%.

Cardiac ejection fraction is a necessary indicator used to determine the prognosis of various cardiovascular diseases.

Causes of heart weakness

A decrease in EF is diagnosed against the background of a variety of diseases. In most cases, the pathology is diagnosed if chronic heart failure develops. This disease appears when:

Ischemic disease. With this disease, blood flow to the coronary arteries, which provide oxygen supply to the heart muscle
Myocardial infarction. In most cases, the pathology develops after transmural and large-focal infarctions. After this critical condition, the muscle cells of the organ are replaced by scar tissue. It cannot contract, which leads to the formation of post-infarction cardiosclerosis
Conduction and rhythm disturbances that are often observed and characterized acute course. Against this background, the muscle gradually wears out. Its contractions are irrational and irregular. In most cases, pathology is diagnosed during the occurrence of various pathological processes that lead to disruption of the organ.
Cardiomyopathies. With this disease, structural abnormalities occur in the configuration of the heart. They occur when the muscles of an organ are stretched or hypertrophied. Reason this pathology may become a violation hormonal levels, long-term arterial hypertension, in which there are high performance blood pressure, organ defects, etc.

A decrease in cardiac ejection fraction can be diagnosed against the background of various cardiac diseases. That is why it is recommended to treat them promptly.

Diagnostics

Values: norm, deviations

The pathological process is characterized by the presence of corresponding signs. Thanks to the symptoms of the disease, doctors are able to make a correct and timely diagnosis.

Patients complain of pain in the right side of the abdomen. It can also increase in size, which is explained by fluid retention in the abdominal cavity.

This condition is observed with venous stagnation. If it is observed for a long period, the patient may develop cardiac cirrhosis of the liver.

Patients may experience shortness of breath not only during physical overload, but also during periods of rest. Patients claim that shortness of breath appears in a lying position, especially at night. In pathology, the development of swelling is diagnosed skin on the face, feet and legs.

Untimely treatment of the pathology leads to swelling of the internal organs, which is explained by impaired blood circulation in the vessels of the subcutaneous fat, which leads to stagnation of fluid in it.

A decrease in cardiac ejection fraction is the cause frequent weakness and excessive fatigue even when doing usual things. In some patients, pathology was diagnosed with frequent occurrence of dizziness. In some cases, loss of consciousness was diagnosed. This is due to insufficient blood supply to the brain and skeletal muscles.

The disease may be accompanied by stool upset, as well as nausea and vomiting. Some people complain of blood appearing in stool. Periodically, impaired sensitivity in the limbs may be observed. At long term pathology, a rapid decrease in body weight is observed. Patients report the appearance of pain in the heart area, which is characterized by varying degrees intensity.

The indicator is determined using an electrocardiogram. Patients are also prescribed an ultrasound examination. Thanks to these examinations, the degree of cardiac output. Diagnostics does not require specific preparation and is highly informative.

Diagnostics of cardiac ejection fraction makes it possible to determine the severity of pathology and production correct tactics therapy.

Treatment

Cardiac ejection fraction: treatment

Pathology therapy is carried out if EF is less than 45 percent. This condition indicates that the functionality of the heart muscle is reduced due to various diseases.

Therapy is aimed at stabilizing pathological changes in the early stages. In most cases, drug therapy is carried out using:

Angiotensin converting enzyme inhibitors. With the help of this medicine, the nutrition of the heart tissue improves, and the peripheral arteries dilate. With regular use of medications, the performance of the heart muscles significantly increases, and the resistance of the myocardium to stress increases. Patients are recommended to take Ramipril, Enalapril, Captopril
Beta blockers. Thanks to these drugs, the organ's need for oxygen and other nutrients is reduced. When using the medicine, the heart rate decreases and the processes of natural cell death decrease. It is recommended to take Metoporolol, Nebivol, Bisoprolol
Aldosterone receptor antagonists. The action of the drugs is aimed at stabilizing the amount of electrolytes. During the treatment period, excess fluid is removed and the load on the organ is reduced. Patients are prescribed Eplerenone, Spironolactone
Diuretics or diuretics. The drugs remove excess fluid from the body and reduce the volume load on the body. Recommended use of Indapamide, Torsemide, Hypothiazide
Cardiac glycosides. The medicine improves the contractility of the heart muscles, increases conductivity in cases of impaired myocardial function. Patients are treated using Strophanthin, Digoxin
Peripheral vasodilators. Medicines are prescribed to reduce the load on the organ and improve blood flow in the area of the heart vessels. Patients are recommended to take Nitroglycerin, Apressin, Sodium nitroprusside
Blockers calcium channels. Thanks to medications, the blood vessels of the heart dilate, and the quality of tissue nutrition also increases. Therapy is carried out with Nifedipine, Nimodipine, Verapamil
Disaggregants. The drugs are recommended to be used to eliminate the possibility of clot formation. For the treatment of pathology, it is recommended to take Aspirin, Plavix
Antirhythmic drugs. Medications relieve disturbances in the rhythm of myocardial contractions. Therapy is carried out with Diltiazem, Disopyramide, Amiodarone

In particularly severe cases, surgical intervention is recommended. Patients are fitted with electrical pacemakers or cardiovector defiblators if there are life-threatening abnormalities in the heart rhythm. In some cases, resynchronization therapy is used. With its help, contractions of the ventricles and atria are stimulated in various rhythms.

During the treatment of pathology, it is necessary to adhere to certain recommendations. The patient needs to be provided with normal nutrition that will fully satisfy the needs of his body. Also, the patient must strictly adhere to the daily routine and rest.

Treatment of reduced cardiac ejection fraction may involve the use of a variety of techniques. The choice of a specific therapeutic method is carried out only by a qualified specialist in accordance with the individual characteristics of the patient and the severity of the pathology.

Prevention

If the patient does not have genetic predisposition, then he can fully regulate the fraction norm. In this case, he is recommended to perform certain rules prevention. A person should exercise every day. It is also recommended to consume foods that contain large amounts of iron.

In order to prevent pathology, it is necessary to quit smoking. A person should minimize the consumption of alcoholic beverages. An excellent preventative method is to maintain a healthy lifestyle.

If possible, a person should go to aerobics several times a week. Diet food will eliminate the threat of pathology development. It is best to give preference to dishes that contain a minimum amount of salt. If you have a hereditary predisposition to the disease, it is recommended to avoid going to the gym.

Cardiac EF is a severe pathological process that can cause fatal outcome. The pathological process can develop in a variety of cardiac diseases. It is accompanied by certain symptoms, upon the appearance of which it is necessary to carry out a diagnosis, which will allow prescribing the optimal treatment regimen. To avoid pathology, its prevention must be carried out in a timely manner.

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Normal value of cardiac ejection fraction, deviations of the indicator

From this article you will learn about cardiac ejection fraction: the norm of the indicator, how it is calculated and what it shows. When a deviation in ejection fraction (EF) is dangerous, why does a pathological change appear. Symptoms of indicators going beyond normal limits, principles of treatment and prognosis.

Ejection fraction (EF) is the ratio of stroke volume (blood that enters the aorta during one contraction of the heart muscle) to the end-diastolic volume of the ventricle (blood that accumulates in the cavity during the period of relaxation, or diastole, of the myocardium). The resulting value is multiplied by 100% to obtain the final value. That is, this is the percentage of blood that the ventricle pushes out during systole from the total volume of fluid it contains.

The indicator is calculated by a computer during an ultrasonographic examination of the heart chambers (echocardiography or ultrasound). It is used only for the left ventricle and directly reflects its ability to perform its function, that is, to ensure adequate blood flow throughout the body.

Under conditions of physiological rest, the normal value of EF is considered to be 50–75%; during physical activity in healthy people it increases to 80–85%. There is no further increase, since the myocardium cannot throw all the blood out of the ventricular cavity, which will lead to cardiac arrest.

In medical terms, only a decrease in the indicator is assessed - this is one of the main criteria for the development of a decrease in cardiac performance, a sign of myocardial contractile failure. This is indicated by an EF value below 45%.

Such insufficiency poses a great danger to life - a small supply of blood to the organs disrupts their functioning, which ends in multiple organ dysfunction and ultimately leads to the death of the patient.

Considering that the reason for the decrease in left ventricular ejection volume is its systolic failure (as the outcome of many chronic pathologies heart and blood vessels), it is impossible to completely cure this condition. Treatment is carried out to support the myocardium and aimed at stabilizing the condition at one level.

Cardiologists and therapists are involved in monitoring and selecting therapy for patients with low ejection fraction. Under certain conditions, the assistance of a vascular or endovascular surgeon may be required.

Features of the indicator

The ejection fraction does not depend on the gender of the person.
With age, a physiological decline in this indicator is noted.
Low EF may be an individual norm, but a value less than 45% is always considered pathological.
All healthy people have an increase in value with an increase in heart rate and blood pressure levels.
The normal indicator when measuring by radionucleide angiography is considered to be 45–65%.
The Simpson or Teicholz formulas are used for measurement; normal values, depending on the method used, range up to 10%.
A critical level of reduction of 35% or less is a sign of irreversible changes in myocardial tissue.
For children in the first years of life, higher rates of 60–80% are typical.
The indicator is used to determine the prognosis of any cardiovascular disease in patients.

Reasons for the decline

On initial stages any disease, the ejection fraction remains normal due to the development of adaptation processes in the myocardium (thickening of the muscle layer, increased work, restructuring of small blood vessels). As the disease progresses, the heart's capacity becomes exhausted, the contractility of muscle fibers becomes impaired, and the volume of ejected blood decreases.

Such disorders are caused by all influences and diseases that have negative action to the myocardium.

Acute myocardial infarction

Scar changes in cardiac tissue (cardiosclerosis)

Painless form of ischemia

Tachy and bradyarrhythmias

Ventricular wall aneurysm

Endocarditis (changes in the inner lining)

Pericarditis (heart sac disease)

Congenital abnormalities of normal structure or defects (violation correct location, significant reduction in the lumen of the aorta, pathological connection between large vessels)

Aneurysm of any part of the aorta

Aortoarteritis (damage to the walls of the aorta and its branches by cells of their own immunity)

Thromboembolism of pulmonary vessels

Diabetes mellitus and impaired glucose absorption

Hormone-active tumors of the adrenal glands, pancreas (pheochromocytoma, carcinoid)

Stimulating narcotic drugs

Symptoms of a decrease in indicator

Low ejection fraction is one of the main criteria for cardiac dysfunction, so patients are forced to significantly limit their work and physical activity. Often, even simple housework causes a deterioration in the condition, which forces you to spend most of your time sitting or lying in bed.

Manifestations of a decrease in the indicator are distributed by frequency of occurrence from the most frequent to the rarer:

significant loss of strength and fatigue from usual activities;
breathing disorders such as an increase in frequency, up to attacks of suffocation;
breathing problems worsen when lying down;
collapsed states and loss of consciousness;
changes in vision (darkening in the eyes, “spots”);
pain in the projection of the heart of varying intensity;
increased number of heart contractions;
swelling of the legs and feet;
fluid accumulation in chest and stomach;
gradual increase in liver size;
progressive weight loss;
episodes of impaired coordination and gait;
periodic decrease in sensitivity and active mobility in the limbs;
discomfort, moderate pain in the projection of the abdomen;
unstable stool;
attacks of nausea;
vomiting with blood;
blood in stool.

Treatment if the indicator decreases

An ejection fraction of less than 45% is a consequence of changes in the functionality of the heart muscle against the background of progression of the underlying disease-cause. A decrease in the indicator is a sign of irreversible changes in myocardial tissue, and the possibility complete cure there is no longer any talk. All therapeutic measures are aimed at stabilizing pathological changes in their early stage and improving the patient’s quality of life – at a later stage.

The treatment complex includes:

carrying out correction of the underlying pathological process;
treatment of left ventricular failure.

This article is devoted directly to left ventricular ejection fraction and the types of its disorders, so further we will only talk about this part of the treatment.

Drug correction

Basic drugs

Improving cardiac tissue nutrition

Increasing myocardial resistance to stress

Reliable increase in the performance of the heart muscle

Decrease in heart rate

Reducing the processes of natural death of heart cells under conditions of increased work

Increasing the number of zones with active contraction in the myocardium

Removing excess fluid and reducing the load on the myocardium

Reducing the volume load on the myocardium

Increased conductivity in conditions of impaired myocardial function

Additional funds

Vascular protection in conditions of altered blood flow

Prevention of clot formation due to venous stagnation

Ancillary drugs

Improving blood flow in the heart vessels

Surgical correction

Installation of pacemakers or cardiovector defibrillators for life-threatening cardiac arrhythmias.
Resynchronization therapy - stimulation of contraction of the ventricles and atria at different rhythms (slowing down the contraction of the ventricles by creating an artificial heart block).

Non-drug correction

Normalization of nutrition in accordance with the needs of the body to stabilize normal weight.
Dosed but mandatory physical activity.
Normalization of the work-rest regime.
Psychotherapeutic assistance.
Physiotherapy and reflexology.

Forecast

If the left ventricular ejection fraction decreases, being in the range of 40-45%, the risk of death due to cardiac arrest is about 10-15%.
A decrease to 35–40% increases this risk to 20–25%.
A further decrease in the indicator exponentially worsens the prognosis for the patient's survival.

There is no complete cure for the pathology, but timely therapy can prolong life and maintain a relatively satisfactory quality of life.

Cardiac output: norm and causes of deviation

When a patient receives test results, he tries to figure out on his own what each value obtained means and how critical the deviation from the norm is. The cardiac output indicator is of important diagnostic value, the norm of which indicates a sufficient amount of blood ejected into the aorta, and a deviation indicates impending heart failure.

What is ejection fraction and why does it need to be assessed?

Cardiac ejection fraction assessment

When a patient comes to the clinic with complaints of heart pain, the doctor will prescribe a full diagnosis. A patient who is encountering this problem for the first time may not understand what all the terms mean, when certain parameters are increased or decreased, how they are calculated.

Cardiac ejection fraction is determined with the following patient complaints:

heart pain;
tachycardia;
dyspnea;
dizziness and fainting;
increased fatigue;
pain in the chest area;
interruptions in heart function;
swelling of the limbs.

Indicative for the doctor will be biochemical analysis blood and electrocardiogram. If the data obtained is not enough, ultrasound, Holter monitoring of the electrocardiogram, and bicycle ergometry are performed.

The ejection fraction is determined by the following heart tests:

isotope ventriculography;
X-ray contrast ventriculography.

Ejection fraction is not a difficult indicator to analyze; even the simplest ultrasound machine shows the data. As a result, the doctor receives data showing how efficiently the heart works with each beat. During each contraction, a certain percentage of blood is ejected from the ventricle into the vessels. This volume is referred to as the ejection fraction. If 60 cm3 of 100 ml of blood in the ventricle entered the aorta, then cardiac output was 60%.

The work of the left ventricle is considered indicative, since from the left part of the heart muscle blood enters big circle blood circulation If malfunctions in the left ventricle are not detected in time, there is a risk of heart failure. A reduced cardiac output indicates the inability of the heart to contract at full strength, therefore the body is not provided with the necessary volume of blood. In this case, the heart is supported with medication.

How is ejection fraction calculated?

The following formula is used for calculation: stroke volume multiplied by heart rate. The result will show how much blood is pumped out by the heart in 1 minute. The average volume is 5.5 liters.

Formulas for calculating cardiac output have names.

Teicholz formula. The calculation is performed automatically by a program into which data on the final systolic and diastolic volume of the left ventricle is entered. The size of the organ also matters.
Simpson's formula. The main difference is the possibility of getting into the slice of the circumference of all parts of the myocardium. The study is more revealing; it requires modern equipment.

Data obtained using two different formulas may differ by 10%. The data is indicative for diagnosing any disease of the cardiovascular system.

Important nuances when measuring the percentage of cardiac output:

the result is not affected by the gender of the person;
the older the person, the lower the rate;
a pathological condition is considered to be below 45%;
a decrease in the indicator of less than 35% leads to irreversible consequences;
the reduced rate may be individual feature(but not lower than 45%);
the indicator increases with hypertension;
in the first few years of life, in children the emission rate exceeds the norm (60-80%).

Normal EF values

Normal more blood passes through the left ventricle, regardless of whether the heart is at the moment loaded or at rest. Determining the percentage of cardiac output allows for timely diagnosis of heart failure.

Normal cardiac ejection fraction values

The cardiac output rate is 55-70%, a reduced rate is read as 40-55%. If the rate drops below 40%, heart failure is diagnosed; a rate below 35% indicates possible irreversible life-threatening heart failure in the near future.

Exceeding the norm is rare, since the heart is physically unable to expel more blood volume into the aorta than required. The indicator reaches 80% in trained people, in particular, athletes, people leading a healthy, active image life.

An increase in cardiac output may indicate myocardial hypertrophy. At this moment, the left ventricle tries to compensate for the initial stage of heart failure and pushes out blood with greater force.

Even if the body is not affected by external irritating factors, it is guaranteed that 50% of the blood will be expelled with each contraction. If a person is concerned about his health, then after the age of 40, it is recommended to undergo an annual physical examination with a cardiologist.

The correctness of the prescribed therapy also depends on determining the individual threshold. An insufficient amount of processed blood causes a deficiency of oxygen supply in all organs, including the brain.

Causes of reduced cardiac ejection fraction

The following pathologies lead to a decrease in cardiac output:

coronary heart disease;
myocardial infarction;
heart rhythm disturbances (arrhythmia, tachycardia);
cardiomyopathy.

Each pathology of the heart muscle affects the functioning of the ventricle in its own way. During coronary heart disease, blood flow decreases; after a heart attack, the muscles become covered with scars that cannot contract. Rhythm disturbances lead to deterioration of conductivity, rapid wear and tear of the heart, and cardiomyopathy leads to an increase in muscle size.

At the first stage of any disease, the ejection fraction does not change much. The heart muscle adapts to new conditions, the muscle layer grows, and small blood vessels are rebuilt. Gradually, the capacity of the heart is exhausted, the muscle fibers are weakened, and the volume of absorbed blood decreases.

Other diseases that reduce cardiac output:

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

Symptoms of reduced ejection fraction

A low ejection fraction indicates serious cardiac pathologies. Having received a diagnosis, the patient needs to reconsider his lifestyle and eliminate excessive stress on the heart. Emotional disorders can cause the condition to worsen.

The patient complains of the following symptoms:

increased fatigue, weakness;
feeling of suffocation;
breathing problems;
difficulty breathing when lying down;
visual disturbances;
loss of consciousness;
heart pain;
increased heart rate;
swelling of the lower extremities.

At more advanced stages and with the development of secondary diseases, the following symptoms occur:

decreased sensitivity of the limbs;
liver enlargement;
lack of coordination;
weight loss;
nausea, vomiting, blood in stool;
abdominal pain;
accumulation of fluid in the lungs and abdominal cavity.

Even if there are no symptoms, this does not mean that the person does not have heart failure. Conversely, pronounced symptoms listed above will not always result in a reduced percentage of cardiac output.

Ultrasound - norms and interpretation

Ultrasound examination of the heart

An ultrasound examination provides several indicators by which the doctor judges the condition of the heart muscle, in particular the functioning of the left ventricle.

Cardiac output, normal 55-60%;
The size of the atrium of the right chamber, the norm is 2.7-4.5 cm;
Aortic diameter, normal 2.1-4.1 cm;
The size of the atrium of the left chamber, the norm is 1.9-4 cm;
Stroke volume, normsm.

It is important to evaluate not each indicator separately, but the overall clinical picture. If there is a deviation from the norm up or down in only one indicator, you will need additional research to determine the cause.

When is treatment for reduced ejection fraction required?

Immediately after receiving the ultrasound results and determining a reduced percentage of cardiac output, the doctor will not be able to determine a treatment plan and prescribe medications. The cause of the pathology should be dealt with, and not with the symptoms of reduced ejection fraction.

Therapy is selected after a complete diagnosis, determination of the disease and its stage. In some cases this is drug therapy, sometimes surgery.

How to increase reduced ejection fraction?

First of all, medications are prescribed to eliminate the root cause of the reduced ejection fraction. Mandatory item treatment is to take drugs that increase myocardial contractility (cardiac glycosides). The doctor selects the dosage and duration of treatment based on test results; uncontrolled use can lead to glycoside intoxication.

Heart failure is treated not only with pills. The patient must control the drinking regime; the daily volume of fluid consumed should not exceed 2 liters. It is necessary to remove salt from the diet. Additionally, diuretics, beta-blockers, ACE inhibitors, Digoxin. Medicines that reduce the heart's need for oxygen will help alleviate the condition.

Modern surgical methods restore blood flow in case of coronary disease and eliminate severe heart defects. An artificial heart driver can be installed for arrhythmia. The operation is not performed if the percentage of cardiac output drops below 20%.

Prevention

Preventive measures are aimed at improving the condition of the cardiovascular system.

Active lifestyle.
Sports activities.
Proper nutrition.
Quitting bad habits.
Rest on fresh air.
Relief from stress.

What is cardiac ejection fraction:

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Symptoms of indicators going beyond normal limits, principles of treatment and prognosis.

Considering that the reason for the decrease in left ventricular ejection volume is its systolic failure (as is the outcome of many chronic pathologies of the heart and blood vessels), it is impossible to completely cure this condition. Treatment is carried out to support the myocardium and aimed at stabilizing the condition at one level.

Features of the indicator

The ejection fraction does not depend on the gender of the person.
With age, a physiological decline in this indicator is noted.
Low EF may be an individual norm, but a value less than 45% is always considered pathological.
All healthy people have an increase in value with an increase in heart rate and blood pressure levels.
The normal indicator when measuring by radionucleide angiography is considered to be 45–65%.
The Simpson or Teicholz formulas are used for measurement; normal values, depending on the method used, range up to 10%.
A critical level of reduction of 35% or less is a sign of irreversible changes in myocardial tissue.
For children in the first years of life, higher rates of 60–80% are typical.
The indicator is used to determine the prognosis of any cardiovascular disease in patients.

Reasons for the decline

At the initial stages of any disease, the ejection fraction remains normal due to the development of adaptation processes in the myocardium (thickening of the muscle layer, increased work, restructuring of small blood vessels). As the disease progresses, the heart's capacity becomes exhausted, the contractility of muscle fibers becomes impaired, and the volume of ejected blood decreases.

Such disorders are caused by all influences and diseases that have a negative effect on the myocardium.

Acute myocardial infarction

Scar changes in cardiac tissue (cardiosclerosis)

Painless form of ischemia

Tachy and bradyarrhythmias

Ventricular wall aneurysm

Endocarditis (changes in the inner lining)

Pericarditis (heart sac disease)

Congenital disorders of the normal structure or defects (violation of the correct location, significant reduction in the lumen of the aorta, pathological connection between large vessels)

Aneurysm of any part of the aorta

Aortoarteritis (damage to the walls of the aorta and its branches by cells of their own immunity)

Thromboembolism of pulmonary vessels

Diabetes mellitus and impaired glucose absorption

Hormone-active tumors of the adrenal glands, pancreas (pheochromocytoma, carcinoid)

Stimulant drugs

Symptoms of a decrease in indicator

Manifestations of a decrease in the indicator are distributed by frequency of occurrence from the most frequent to the rarer:

significant loss of strength and fatigue from usual activities;
breathing disorders such as an increase in frequency, up to attacks of suffocation;
breathing problems worsen when lying down;
collapsed states and loss of consciousness;
changes in vision (darkening in the eyes, “spots”);
pain in the projection of the heart of varying intensity;
increased number of heart contractions;
swelling of the legs and feet;
accumulation of fluid in the chest and abdomen;
gradual increase in liver size;
progressive weight loss;
episodes of impaired coordination and gait;
periodic decrease in sensitivity and active mobility in the limbs;
discomfort, moderate pain in the projection of the abdomen;
unstable stool;
attacks of nausea;
vomiting with blood;
blood in stool.

Treatment if the indicator decreases

An ejection fraction of less than 45% is a consequence of changes in the functionality of the heart muscle against the background of progression of the underlying disease-cause. A decrease in the indicator is a sign of irreversible changes in the myocardial tissue, and there is no talk of the possibility of a complete cure. All therapeutic measures are aimed at stabilizing pathological changes at their early stages and improving the patient’s quality of life at a later stage.

The treatment complex includes:

carrying out correction of the underlying pathological process;
treatment of left ventricular failure.

This article is devoted directly to left ventricular ejection fraction and the types of its disorders, so further we will only talk about this part of the treatment.

Drug correction

Basic drugs

Improving cardiac tissue nutrition

Increasing myocardial resistance to stress

Reliable increase in the performance of the heart muscle

Decrease in heart rate

Reducing the processes of natural death of heart cells under conditions of increased work

Increasing the number of zones with active contraction in the myocardium

Removing excess fluid and reducing the load on the myocardium

Reducing the volume load on the myocardium

Increased conductivity in conditions of impaired myocardial function

Additional funds

Vascular protection in conditions of altered blood flow

Prevention of clot formation due to venous stagnation

Ancillary drugs

Improving blood flow in the heart vessels

Surgical correction

Installation of pacemakers or cardiovector defibrillators for life-threatening cardiac arrhythmias.
Resynchronization therapy - stimulation of contraction of the ventricles and atria at different rhythms (slowing down the contraction of the ventricles by creating an artificial heart block).

Non-drug correction

Normalization of nutrition in accordance with the needs of the body to stabilize normal weight.
Dosed but mandatory physical activity.
Normalization of the work-rest regime.
Psychotherapeutic assistance.
Physiotherapy and reflexology.

Forecast

If the left ventricular ejection fraction decreases, being in the range of 40-45%, the risk of death due to cardiac arrest is about 10-15%.
A decrease to 35–40% increases this risk to 20–25%.
A further decrease in the indicator exponentially worsens the prognosis for the patient's survival.

There is no complete cure for the pathology, but timely therapy can prolong life and maintain a relatively satisfactory quality of life.

Left ventricular ejection fraction of the heart: norms, reasons for low and high, how to increase

What is ejection fraction and why does it need to be assessed?

Cardiac ejection fraction (EF) is an indicator that reflects the volume of blood ejected by the left ventricle (LV) at the time of its contraction (systole) into the lumen of the aorta. EF is calculated based on the ratio of the volume of blood ejected into the aorta to the volume of blood present in the left ventricle at the moment of its relaxation (diastole). That is, when the ventricle is relaxed, it contains blood from the left atrium (end-diastolic volume - EDV), and then, contracting, it pushes part of the blood into the lumen of the aorta. This part of the blood is the ejection fraction, expressed as a percentage.

The ejection fraction of blood is a value that is technically easy to calculate, and which has a fairly high information content regarding myocardial contractility. The need to prescribe cardiac medications largely depends on this value, and also determines the prognosis for patients with cardiovascular failure.

The closer to normal values the patient’s LV ejection fraction, the better his heart contracts and the more favorable the prognosis for life and health. If the ejection fraction is much lower than normal, it means that the heart cannot contract normally and supply blood to the entire body, and in this case, the heart muscle should be supported with the help of medications.

How is ejection fraction calculated?

This indicator can be calculated using the Teicholtz or Simpson formula. 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.

The calculation using the Simpson method is considered more successful, since according to Teicholz, small areas of the myocardium with impaired local contractility may not be included in the research slice during two-dimensional Echo-CG, while with the Simpson method, larger areas of the myocardium fall into the circle slice.

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

Normal EF values

The normal value for ejection fraction varies from person to person and also depends on the equipment used for the study and the method by which the fraction is calculated.

The average values are approximately 50-60%, the lower limit of normal according to the Simpson formula is at least 45%, according to the Teicholz formula - at least 55%. This percentage means that exactly this amount of blood in one heartbeat it is necessary to push the heart into the lumen of the aorta to ensure adequate oxygen delivery to the internal organs.

35-40% speak about advanced heart failure, even more low values are fraught with immediate consequences.

In children in the neonatal period, EF is at least 60%, mostly 60-80%, gradually reaching normal levels as they grow.

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

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

Sometimes in the conclusion of echocardioscopy you can see that the EF value is higher than the average indicators (60% or more). As a rule, in such cases the figure is no more than 80%, since the larger volume of blood in the left ventricle due to physiological characteristics will not be able to expel into the aorta.

As a rule, high EF is observed in healthy individuals in the absence of other cardiac pathology, as well as in athletes with trained heart muscle, when the heart contracts with each beat with greater force than in ordinary person, and expels a greater percentage of the blood contained in it into the aorta.

In addition, if the patient has LV myocardial hypertrophy as a manifestation of hypertrophic cardiomyopathy or arterial hypertension, an increased EF may indicate that the heart muscle can still compensate for incipient heart failure and seeks to expel into the aorta as much as possible more blood. As heart failure progresses, EF gradually decreases, so for patients with clinically manifested CHF it is very important to perform echocardioscopy over time so as not to miss a decrease in EF.

Causes of reduced cardiac ejection fraction

The main cause of impaired systolic (contractile) myocardial function is the development of chronic heart failure (CHF). In turn, CHF occurs and progresses due to diseases such as:

Coronary heart disease is a decrease in blood flow through the coronary arteries, which supply oxygen to the heart muscle itself,
Previous myocardial infarctions, especially large-focal and transmural (extensive), as well as repeated ones, as a result of which normal muscle cells hearts after a heart attack are replaced by scar tissue that does not have the ability to contract - post-infarction cardiosclerosis is formed (in ECG description can be seen as the abbreviation PICS),

Decreased EF due to myocardial infarction (b). Affected areas of the heart muscle cannot contract

Most common cause decreases in cardiac output are acute or previous heart attacks myocardium, accompanied by a decrease in global or local contractility of the left ventricular myocardium.

Symptoms of reduced ejection fraction

All symptoms that may indicate a decrease in contractile function hearts, caused by CHF. Therefore, the symptoms of this disease come first.

However, according to the observations of practicing ultrasound diagnostic doctors, the following is often observed - in patients with severe signs of CHF, the ejection fraction remains within the normal range, while in people with no obvious symptoms, the ejection fraction is significantly reduced. Therefore, despite the absence of symptoms, patients with cardiac pathology must undergo echocardioscopy at least once a year.

So, symptoms that suggest a violation of myocardial contractility include:

Attacks of shortness of breath at rest or during physical activity, as well as when lying down, especially at night,
The load that provokes the occurrence of shortness of breath attacks can be different - from significant, for example, walking long distances (we are sick), to minimal household activity, when it is difficult for the patient to perform the simplest manipulations - cooking, tying shoelaces, walking to the next room, etc. d,
Weakness, fatigue, dizziness, sometimes loss of consciousness - all this indicates that the skeletal muscles and brain receive little blood,
Swelling on the face, legs and feet, and in severe cases - in internal cavities body and throughout the body (anasarca) due to impaired blood circulation through the vessels of the subcutaneous fatty tissue, in which fluid retention occurs,
Pain in the right half of the abdomen, an increase in abdominal volume due to fluid retention in the abdominal cavity (ascites) - occurs due to venous stagnation in the hepatic vessels, and long-term stagnation can lead to cardiac cirrhosis of the liver.

In the absence of proper treatment for systolic myocardial dysfunction, such symptoms progress, increase and become increasingly difficult for the patient to tolerate, therefore, if even one of them occurs, you should consult a general practitioner or cardiologist.

When is treatment for reduced ejection fraction required?

Of course, no doctor will offer to treat you low rate obtained from cardiac ultrasound. First, the doctor must identify the cause of the reduced EF, and then prescribe treatment for the causative disease. Depending on it, treatment may vary, for example, taking nitroglycerin drugs for coronary artery disease, surgical correction of heart defects, antihypertensive drugs for hypertension, etc. It is important for the patient to understand that if there is a decrease in the ejection fraction, it means that heart failure is really developing and it is necessary to follow the doctor’s recommendations for a long time and scrupulously.

How to increase reduced ejection fraction?

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

To prevent volume overload of the heart, that is, excess fluid, it is recommended to follow a diet limiting table salt to 1.5 grams per day and limiting fluid intake to 1.5 liters per day. Diuretic drugs (diuretics) are also successfully used - diacarb, diuver, veroshpiron, indapamide, torasemide, etc.

To protect the heart and blood vessels from the inside, drugs with so-called organoprotective properties - ACE inhibitors - are used. These include enalapril (Enap, Enam), perindopril (Prestarium, Prestans), lisinopril, captopril (Capoten). Also among drugs with similar properties, ARA II inhibitors are widely used - losartan (Lorista, Lozap), valsartan (Valz), etc.

The treatment regimen is always selected individually, but the patient must be prepared for the fact that the ejection fraction does not return to normal immediately, and symptoms may persist for some time after the start of therapy.

In some cases, the only method to cure the disease that caused the development of CHF is surgery. Surgeries may be needed to replace valves, install stents or shunts on coronary vessels, install a pacemaker, etc.

However, in cases of severe heart failure (functional class III-IV) with extremely low ejection fraction, surgery may be contraindicated. For example, a contraindication to mitral valve replacement is a decrease in EF of less than 20%, and to implantation of a pacemaker - less than 35%. However, contraindications to operations are identified during an in-person examination by a cardiac surgeon.

Prevention

The preventive focus on preventing cardiovascular diseases leading to low ejection fraction remains especially relevant in the modern environmentally unfavorable environment, in the era of a sedentary lifestyle in front of computers and eating low-health foods.

Even based on this, we can say that frequent recreation outside the city in the fresh air, healthy eating, adequate physical activity (walking, light jogging, exercises, gymnastics), giving up bad habits - all this is the key to long-term and proper functioning of the cardiovascular system with normal contractility and fitness of the heart muscle.

How to increase left ventricular ejection fraction?

03/24/2017, Daut, 57 years old

Medicines taken: warfarin, egilok, coraxan, etc.

Conclusion of ECG, ultrasound, other studies: Extensive infarction on November 4, 2016, on the same day an operation was performed to replace the aortic valve, left ventricular fibrillation, and installation of a pacemaker. Fraction is now 29-30, pressure 90/60, heart rate 70-80

Complaints: Complaints: 4.5 months have passed since the operation, the suture site is constantly tightening, acute stomach pain. Initially, 2 tablets per day were prescribed; I purchased a device for determining INR for home use. Every day different results. The latest figure is 3.7. Weakness, fatigue.

How to increase left ventricular ejection fraction, is this possible?

Possible causes of acute pain in the stomach, difficulty walking, what should be done?

4 Comments

If the ejection fraction has decreased as a result of a heart attack, then this is usually not reversible, all you can do is follow the recommendations of your cardiologist, often even with such a fraction people can cope with everyday needs.

The problem with the “stomach” needs to be solved separately with a gastroenterologist.

Very interesting, thanks for the answer

How to increase the left ventricular fraction, 3 month old newborn, bicuspid VPS aortic valve, aortic valve stenosis?

There are no ways to do this, it all depends only on the heart itself. Some drugs for the treatment of heart failure can improve the situation somewhat, but this is definitely of no use to a newborn; the cause must be eliminated.

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VERY LOW EMISSION FRACTION

I have been ill for a long time since 2009, and was examined after the sudden death of my twin brother. Until 2013 I received outpatient treatment stationary, but without effect. The ejection fraction periodically decreased to 35%. Deterioration since 2012. during additional examination (TEX) carotid sinus syndrome. According to Holter Monitoring, extrasystolic arrhythmia high class. Implantation of a Cardiac Defebrillator was recommended. Refused. In 2013, an operation was performed to implant a CRT-D pacemaker. At discharge, EF was 38%. Three months later, attacks of ventricular tachycardia, 3 episodes, were stopped by defebrillator discharges. During hospitalization, EF was 13%. After infusion of Levosimendan, the positive dynamics of EF was 22%. In January 2014, three more episodes of tachycardia and defebrillator discharge. after these cases, the EF is 12-14%, and there is no dynamics with treatment. I am a permanent patient in the Cardiac Surgery Department. Treatment both in the department and on an outpatient basis: I take tablets: Cordarone, Coriol, Inspra, mildronate, etatsizin, cardiomagnyl, thiotriazoline. I live on disability. I would like to inform you that I have never used nicotine, alcohol or other drugs, I have always sporty look life. Doctors say one thing: an organ transplant is necessary. Maybe someone can give advice and consultation on how to improve the ejection fraction and improve the condition. Big thanks and respect to everyone!

When they talk about arrhythmogenic cardiopathy (if they do not mean arrhythmogenic cardiopathy of the right ventricle, but then there would be no decrease in the ejection fraction of the left ventricle), they believe that weakness of the heart muscle has developed as a result of arrhythmia. This can be a very frequent extrasystole (approximately 16-20% of all heartbeats are extrasystoles) or atrial fibrillation. You write that you are being led on CORDARON and ETACISINE. If these antiarrhythmics reliably stop extrasystole and ventricular tachycardia, then all the conditions for restoring the ejection fraction have been created. Since it remains low, transplantation does seem to be a good option. If frequent extrasystry continues despite this treatment, there may be a chance of improving ejection fraction and avoiding transplantation if radiofrequency ablation is performed and the arrhythmia is eliminated. Defibrillator shocks could not play a significant role in reducing the ejection fraction. Here we need to figure out if severe arrhythmia is primary, then we can count on the success of ablation. And if this is primary cardiomyopathy, then there is nothing left but a transplant.

The concept of “ejection fraction” is of interest not only to specialists. Any person who is undergoing examination or treatment for heart and vascular diseases may encounter the concept of ejection fraction. Most often, the patient hears this term for the first time while undergoing an ultrasound examination of the heart - dynamic echography or X-ray contrast examination. In Russia, thousands of people require imaging examinations every day. More often carried out ultrasound examination heart muscle. It is after such an examination that the patient is faced with the question: ejection fraction - what is the norm? You can get the most accurate information from your doctor. In this article we will also try to answer this question.

Heart diseases in our country

Diseases of the cardiovascular system in civilized countries are the first cause of death for 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, sedentary lifestyle, carbohydrate metabolism disorders, high cholesterol, high blood pressure and some others. If you have several risk factors or complaints from the cardiovascular system, you should seek medical help from a doctor for examination. general practice or a cardiologist. 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.

What examinations can a cardiologist prescribe?

The doctor may be alerted by the patient's complaints of pain in the heart, pain in the chest, interruptions in heart function, rapid heartbeat, shortness of breath when physical activity, dizziness, fainting states, swelling in the legs, fatigue, decreased performance, weakness. The first tests are usually an electrocardiogram and a biochemical blood test. Next, Holter monitoring of the electrocardiogram, bicycle ergometry and ultrasound examination of the heart can be performed.

What studies will show the ejection fraction?

Ultrasound examination of the heart, as well as radiopaque or isotope ventriculography will help obtain information about the ejection fraction of the left and right ventricles. Ultrasound examination is the cheapest, safest and least burdensome for the patient. Even the simplest ultrasound machines can give an idea of cardiac ejection fraction.

Cardiac ejection fraction

Ejection fraction is a measure of how much work the heart does with each beat. The ejection fraction is usually called the percentage of the volume of blood ejected into the vessels from the ventricle of the heart during each contraction. If there were 100 ml of blood in the ventricle, and after the heart contracted, 60 ml entered the aorta, then we can say that the ejection fraction was 60%. When you hear the term “ejection fraction,” we are usually talking about the function of the left ventricle of the heart. Blood from the left ventricle enters the systemic circulation. It is left ventricular failure that leads to the development clinical picture heart failure most often. The ejection fraction of the right ventricle can also be assessed with ultrasound examination of the heart.

Ejection fraction - what is the norm?

A healthy heart, even at rest, pumps more than half of the blood from the left ventricle into the vessels with each beat. If this figure is significantly lower, then we are talking about heart failure. This condition can be caused by myocardial ischemia, cardiomyopathy, heart defects and other diseases. So, the normal left ventricular ejection fraction is 55-70%. A value of 40-55% indicates that the ejection fraction is below normal. An indicator of less than 40% indicates the presence of heart failure. If the left ventricular ejection fraction decreases to less than 35%, the patient is at high risk of life-threatening interruptions in cardiac function.

Low ejection fraction

Now that you know your ejection fraction standards, you can evaluate how your heart is working. If your left ventricular ejection fraction is lower than normal on echocardiography, you will need to see your doctor immediately. It is important for the cardiologist not only to know 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. Low ejection fraction may be a predisposing factor for feeling unwell, swelling and shortness of breath. Currently, a cardiologist has tools to treat diseases that cause low ejection fraction. The main thing is constant outpatient monitoring of the patient. In many cities, specialized cardiology clinics have been organized for free dynamic monitoring of patients with heart failure. The cardiologist may prescribe conservative treatment pills or surgical procedures.

Methods for treating low cardiac ejection fraction

If the cause of low cardiac ejection fraction is heart failure, then appropriate treatment will be required. The patient is recommended to limit fluid intake to less than 2 liters per day. The patient will also have to stop using table salt in food. The cardiologist may prescribe medications: diuretics, digoxin, ACE inhibitors or beta blockers. Diuretic medications somewhat reduce the volume of circulating blood, and therefore the amount of work done by the heart. Other drugs reduce the oxygen demand of the heart muscle, making its function more effective, but less expensive.

Plays an increasingly important role surgical treatment reduced cardiac ejection fraction. Surgeries have been developed to restore blood flow in the coronary vessels in case of coronary heart disease. Surgery is also used to treat severe heart valve defects. According to indications, artificial cardiac pacemakers can be installed to prevent arrhythmia in the patient and eliminate fibrillation. Cardiac interventions are long-term, difficult operations that require extremely high qualifications from the surgeon and anesthesiologist. Therefore, such operations are usually performed only in specialized centers in large cities.

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During surgery: the right chambers of the heart are enlarged. The septal valve is retracted to the FC of the TC.

During inspection of the IVS, a subaortic VSD of 8*7 mm was revealed. The VSD is closed with a “Kemperiplas” patch,

fixed continuous-wrap seam. Suturing LLC.

When revising the valve, the LA valve is bicuspid, the leaflets are fused along the commissures.

An open commissurotomy of the pulmonary valve was performed.

A control examination on 09/05/11 showed three defects of 0.1 cm each in the IVS patch area, discharge into the pancreas (р 65 mmHg)

Pericardium-b/o. Pleural cavities - b/o. TK - 2nd degree regurgitation (р9 mmHg, due to the LV component).

Myocardial contractility is satisfactory.

From 08/12/15-08/18/15 we were examined at the Kemerovo Cardiology Center for an examination and this is what it showed:

CDR:3.5cm; DAC:2 cm; KDO:51ml; KSO:13 ml; LA 2 cm; RV 1 cm; IVS 0.4 cm; LVSD 0.4 cm.

Ascending aorta 2 cm. VO38 ml; MM 31g; LA-Barrel 2.2 cm (extended)

OS - moderate LV dilatation.

MK-not changed; AK-not changed; TK - 1st degree regurgitation; KLA-Pmax 12mmHg regurgitation 3rd degree;

PAP system - 27 mmHg. Local contractility is not impaired.

Along the edge of the patch there is a 0.35 cm suture shunt with discharge into the pancreas.

According to ECG - Rhythm-minus, heart rate 75 beats/min. P:0.08s P-Q:0.1s QRS:0.13s Q-T:0.370 Complete blockade right leg of the His.

X-ray of the lungs - hypervolemia according to the MCC. Expansion of the boundaries of the heart. The child is already 4 years old.

Please tell me whether we need surgical treatment now or later.

And in general you can’t do without it in the future?

Resolving such issues is solely within the competence of your son’s attending physician.

Question: is this a measurement error or has the ejection fraction recovered after stopping work?

There are prospects for improvement. But how much in percentage is, excuse me, a fortune teller.

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A value such as the ejection fraction of the heart is characterized by the amount of blood released into the aorta during contraction. If this indicator decreases, this indicates a deterioration in the performance of the organ and possible emergence heart failure.

When the fraction is very low, less than 30%, then the person is in serious danger. At rest, the left ventricle stores blood that has entered from the atrium. During contractile movement, it releases a certain amount of it into the vascular bed.

Left ventricular ejection fraction (EF) is calculated as the ratio of the volume of blood entering the aorta to the amount in the left ventricle during relaxation. This is the percentage of the volume of biological fluid expelled.

What is it

EF is considered a common indicator that an ultrasound machine can provide. These data indicate the quality of the heart during contraction. During the entire process, the volume of blood that has left the left ventricle into the vascular bed is measured and removed as a percentage.

The measurement is taken in the left ventricle, from here blood is flowing into the systemic circulation. When the indicator decreases, this indicates that the heart cannot contract at full strength and there is a lack of blood volume in the body. In case of minor violations, this situation can be corrected by medication .

Typically, studies are prescribed when the patient complains of shortness of breath, tachycardia, dizziness, fainting, fatigue, pain in the heart or behind the sternum, swelling of the extremities. A biochemical blood test and an electrocardiogram are initially indicated.

Sometimes Holter monitoring or ultrasound is performed to get a complete picture.

How is the emission rate calculated?

There is a calculation formula. To do this, stroke volume is multiplied by heart rate. This is how you get the desired value. The result will tell you how much volume is pushed out in one minute. Generally normal indicator should reach approximately 5.5 liters.

Formulas for calculating ejection fraction

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

EF should be within 50-60%; the Simpson norm suggests that the lower limit should not be less than 45%, and Teicholz 55%.

The Teicholz formula uses systolic and diastolic volume and left ventricular size. Involved in the study small part the last one.

The overall length does not matter.

Typically, the study is carried out on old equipment and in the presence of areas with impaired local contractility (for example, in the case of ischemia), the Teicholz formula may fail and give an unclear result.

To obtain the EF indicator, the volume of shortening is multiplied by a factor of 1.7. The op-amp is obtained from the formula ((KDD - KSD)/KDD)*100%. Where EDD is the end diastolic diameter, ESD is the end systolic diameter.

Simpson's formula is more modern; it accurately shows all significant zones of the myocardium, 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.

The Simpson method involves dividing the left ventricular cavity into thin disks and determining their boundaries. The outlined systole and diastole are visible along the contour of the cardinal surface of the ventricle; from these data, an estimate of the ejection volume can be made.

Standards for adults

The indicators do not depend on the gender of the patient, so the norms are identical for women and men. However, they may differ depending on age. The older a person is, the lower his standard.

An EF of less than 45% is considered reduced. At rates around 40%, heart failure can be suspected.

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

Normal in children

IN younger age the figure may be higher. Thus, the norm for children from birth to 14 years is in the range of 60-80%. However, only one EF cannot be considered; all indicators of heart function are taken into account when making a diagnosis.

The table of norms involves comparisons of height, weight, fraction and heart rate.

What studies are used to establish the indicator?

If the doctor suspects a heart disorder, he directs the patient to do a cardiogram and a biochemical blood test. Holter monitoring, electrocardiogram, bicycle ergometry and ultrasound examination of the organ can also be performed.

Doctors study all indicators at once and judge the presence of pathology based on their total value. The main ones are the following:

Cardiac output should be between 55 and 60%.
The size 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 normal stroke volume is 60-100 cm.

What does a low score mean?

When the indicator is between 55-75%, this is the norm. A reduced value is from 45 to 55%. When it is up to 45, it means the patient has heart failure. If it is below 35%, then irreversible disturbances in the functioning of the organ occur and the person needs urgent treatment.

Reasons for lowering the value

The indicator may be reduced in 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 using medication.
Ischemic disease. This reduces blood flow.
Failure of rhythmic contractions. Leads to conduction disturbances and wear and tear of the heart.
Cardiomyopathies. Causes an increase in muscle size.

Identifying pathology in the early stages and eliminating it through drug therapy can save the situation. If nothing has been done, then gradually the EF decreases even more.

This occurs 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 blood absorption decreases.

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

Angina pectoris.
Hypertension.
Pericarditis, endocarditis, myocarditis.
Aneurysm of the ventricular walls.
Birth defects organ or vessels.
Vasculitis.

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

Symptoms of a low rate

The main symptom when the fraction is reduced is the appearance of shortness of breath, regardless of the load. It can appear even due to minor loads when performing homework. Sometimes shortness of breath may occur at night or when lying down.

Among other signs, patients note:

Increased weakness, fatigue and dizziness, up to loss of consciousness. This is due to a lack of blood supply and, as a result, oxygen starvation.
The appearance of edema. This occurs due to fluid stagnation.
Severe pain in right side belly. This is noted due to congestion in the liver vessels, which can further provoke cirrhosis.
Visual impairment.
Pain in the heart area with increased contraction rhythm.
Decreased sensitivity of the limbs.
Loss of coordination.
Nausea, vomiting.

How to increase the value of the indicator

First, the patient is diagnosed to identify the pathology that caused the decrease. Next, medications appropriate to the diagnosis are prescribed. For ischemia, the use of nitroglycerin is indicated; for hypertension, it is prescribed antihypertensive drugs And surgical correction vices.

In addition to treating the underlying disease, contractile function is stabilized. These include Digoxin, Korglykon, Strophanthin.

To prevent the cardiovascular system from being overloaded with fluid, it is recommended to follow a diet, reduce salt and the volume of daily fluid.

At the same time, diuretics are indicated to help remove excess fluid: Veroshpiron, Diacarb, Diuver, Indapamide, Torasemide.

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

They help reduce the organ’s need for oxygen and nutritional components, increase the volume of areas of myocardial contraction, reduce cell death and heart rate. Their list includes: Nebivolol, Metoprolol, Bisoprolol.

Aldosterone receptor antagonists stabilize electrolyte blood levels, remove excess fluid, and 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. Valsartan, Candesartan, Olmesartan are prescribed.

When the ejection fraction is low, statins may be used as adjunctive therapy to reduce cholesterol levels and protect blood vessels. Pravastatin, Fluvastatin, Simvastatin are used.

Anticoagulants are also effective, they thin the blood and prevent atherosclerotic changes. This is Warfarin, Xarelto.

Other treatment methods

In addition to taking appropriate medications, all patients need to reconsider their lifestyle in order to increase their fraction.

Organize proper nutrition.
Get enough rest.
Undergo physiotherapy and reflexology.
Control physical activity.
Be outdoors often.
Give up bad habits.

Surgery

In cases where drug therapy is ineffective, surgical treatment may be prescribed.

Its common methods are:

Installation of a cardioverter-defibrillator, pacemaker for heart rhythm disturbances.
Creating an artificial block to slow ventricular contraction in order to stimulate different rhythms of contraction of the atria and ventricles.

Home Remedies

Promote folk remedies faction is almost impossible.

Basically, this therapy is aimed at eliminating symptoms and maintaining organ function. So, to prevent swelling, take decoctions of calendula, milk thistle, horsetail, yarrow, knotweed, nettle, chicory, birch buds, juniper berries, rose hips, and lingonberries. They should be drunk in the intervals when you are cancelled. medical supplies similar action.

A decoction of mistletoe, hawthorn and dried herbs, taken in equal quantities, is considered effective. Pour two tablespoons of the mixture into a liter of boiling water and place on low heat. After a couple of minutes, set aside the brew and leave for about half an hour. After straining, take 125 ml three times a day.
Dried hawthorn fruits in a volume of 6 tablespoons are ground and motherwort herb is added in the same quantity. Pour the mixture into 1.5 liters of boiling water and let it sit for a day, wrapping it well. Then filter and place in the refrigerator. You need to drink one glass three times a day, half an hour before meals.
Hawthorn is often used in the treatment of heart pathologies. It helps normalize heart rhythm, reduce hypertension, chest pain, and fights atherosclerosis and heart failure. Hawthorn flowers and berries help the heart by 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.

Willow bark, meadow clover, sweet clover, meadowsweet, hawthorn, and broom are used to thin the blood.

TO sedative fees include:

Composition of hawthorn, dried cucumber, chamomile, caraway and motherwort.
A decoction of St. John's wort, mistletoe, sage, yarrow, dried grass, calendula, horsetail and pine buds.

For these purposes, you can purchase ready-made tinctures of peony, valerian, motherwort or hawthorn at the pharmacy. If there are no herbs, you can dilute 50 g of honey in 500 ml of water and drink it in 4 doses during the day.

When is a high fraction value diagnosed?

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

Sometimes an increase indicates myocardial hypertrophy, when the left ventricle strives to compensate for incipient CHF and pushes out blood with considerable force.

If the indicators are not normal, it is imperative to consult a cardiologist and undergo echocardioscopy to prevent the development of pathologies.

Consequences

If you do not pay attention to the problem, severe chronic heart failure develops. Moreover, the body experiences a lack of oxygen, since the blood is pushed out in insufficient quantities and does not carry all the necessary nutrients.

Oxygen starvation can lead to serious pathologies of both the heart and brain.

Health forecast

The prognosis depends on how low the indicator is diagnosed in the patient. When the value decreases to 40-45%, the risk of cardiac arrest is small, about 10-15%. When EF decreases to 34-39%, the possibility of death is within 20-25%.

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

It is not possible to completely get rid of the pathology, so patients with this diagnosis must constantly undergo corrective therapy, which will allow them to maintain their vital functions for many years.

Ejection fraction provides information about the performance of the left ventricle. In men and women, the norm is the same (55-70%), but in children the figure can reach 70-80%, which is not considered a pathology.

The most common is the low fraction. To raise the rate, 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 and death.

Cardiac ejection fraction (EF) is a value that determines the efficiency of the heart. Basically, this indicator is characterized by the amount of blood that, during the period of contraction, is pushed into the aortic space by the left ventricle. In a calm state, the ventricle contains blood from the left atrium inside; at the moment of contraction, it throws part of it into the vessels. Left ventricular ejection fraction is the percentage ratio of the amount of blood pushed into the aorta to the volume of blood in the left ventricle, which is in a relaxed state. The volume of blood ejected, expressed as a percentage, is called the ejection fraction.

Such a concept as ejection fraction determines the functionality of the left ventricle, since it ejects blood into the systemic circulation. As the ejection fraction decreases, heart failure develops.

Indications for prescribing ejection fraction studies may include patient complaints:

heart pain;
chest pain;
interruptions in heart activity;
tachycardia;
fainting and dizziness;
weakness;
decreased performance;
swelling of the limbs.

First, as a rule, an electrocardiogram and blood test are prescribed, then Holter monitoring of the electrocardiogram, bicycle ergometry and ultrasound of the heart may be prescribed.

How is PV calculated?

Ejection fraction is easy to calculate and contains sufficient information about the ability of the myocardium to contract. The use of drugs in the treatment of patients with cardiovascular failure depends on this indicator. Studies such as Doppler sonography are widely used to establish the value of left ventricular ejection fraction.

The ejection fraction can be determined using the Teicholz formula or the Simpson method:

Using M-modal echocardiography (parasternal access), the ventricular ejection fraction is determined using the Teicholz formula (Teichholz L. E., 1976). A small part of the ventricle at the base is subject to study; its length is not taken into account. The formula gives inaccurate results when examining patients with ischemia, when there are areas with impaired local contractility. Using information about the systolic and diastolic volume of the left ventricle and its dimensions, the program automatically calculates the result. The method is used on outdated equipment.
Quantitative two-dimensional echocardiography (apical access) is a method that is more accurate compared to the previous one. In modern ultrasound diagnostic clinics, they use the Simpson algorithm (Simpson J. S., 1989) or, as it is also called, the disc method. All significant areas of the myocardium are included in the field of view during the study.

The difference between ejection fraction studies can vary by up to 10%.

Normal fraction emission

At the moment of contraction, the human heart pushes more than 50% of the blood into the blood supply. Heart failure occurs when the level of ejection fraction decreases. Progressive failure of myocardial contractile function may serve as the basis for the development of other changes in the internal organs.

The ejection fraction rate is 55–70%. At 40–55% we can say that EF is below normal. occur when the indicator decreases to 35%: heart failure occurs. To prevent a decrease in EF, it is recommended to visit a cardiologist at least once a year, and for people over forty, this is a prerequisite. When examining patients with heart pathologies, it is important to determine the minimum value of the left ventricular ejection fraction. The choice of treatment tactics for the patient depends on this.

Why might the EF level be overestimated?

If the test results show an indicator of 60% or more, this indicates an overestimated level of ejection fraction. The most high value can reach 80%; the left ventricle is simply unable to pump more blood into the vessels due to its characteristics. Typically, such results are typical for healthy people without other heart pathologies. And for athletes with a trained heart, in whom the heart muscle, contracting with significant force, is able to push out more blood than usual.

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 the systemic circulation. This can be judged by observing an increase in left ventricular EF.

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

Ways to increase low EF

Chronic heart failure - main reason disturbances in the systolic (contractile) function of the myocardium, and therefore a decrease in the ejection fraction. The development of CHF is promoted by:

- reduced amount of blood in the coronary vessels that supply the heart with oxygen.
Myocardial infarction, its large focality and transmurality. The end result is the replacement of healthy heart cells with scars that are unable to contract.
Diseases caused by irregular heart rhythm due to improper contraction.
Cardiomyopathy is stretching or enlargement of the heart muscle. Develops as a result hormonal imbalances, hypertension, heart disease.

Poor health, shortness of breath, swelling of the extremities indicate a low ejection fraction. How to increase the volume of fraction emission? Today, in modern medicine, therapy is in first place among the ways to increase EF. Patients are often observed on an outpatient basis, where the state of the heart, cardiovascular system and drug treatment are examined.

The doctor often prescribes diuretics that can reduce the amount of blood that circulates in the system, and ultimately the load on the heart. As well as glycosides, ACE inhibitors or beta-blockers, which reduce the heart’s need for oxygen, increase performance and reduce the energy requirement of the heart muscle.

In extreme cases, due to the danger of death, such as heart or valve defects, surgery is performed. In all other cases, therapy is indicated. Operations have been developed to restore blood flow in the coronary vessels in case of coronary heart disease and valve defects. During the operation, the valves are resected and prosthetics are performed. Thus, normalization of the rhythm is achieved, arrhythmia and fibrillation disappear.

Cardiovascular surgery requires the professionalism and experience of surgeons, so operations are performed in cardiology centers.

Prevention of low EF

If the patient does not have a predisposition to heart disease, then the value of the left ventricular ejection fraction can be successfully maintained within the normal range.

To prevent normal ejection fraction, doctors recommend:

Sports (aerobics), light exercise.
Don't carry heavy things, go to the gym.
Quitting alcohol and smoking.
Healthy lifestyle.
Eating foods rich in iron.
Reduce salt intake.
Drink 1.5–2 liters of water per day.
Diet.

According to statistics from the 20th century, heart disease mainly affected people in old age. In the 21st century, these pathologies have become significantly younger. The risk group includes residents of megacities who live in conditions with high content car exhaust and low oxygen.