Do You Know Your Heart’s Ejection Fraction?

Today I ran into a young woman I assisted in Cardiac Rehabilitation after she had a heart incident. One of the first things she said to me with a smile on her face was that her ejection fraction had increased from 15% to 55%. This means her heart essentially is functioning within normal limits of 50%-70%  in it’s pumping ability. She went on to tell me she was off to go snowshoeing in the woods. I was so proud, as working with patients over time you learn and share a lot about your lives, and for her this was huge!

Ejection fraction is a measurement of the percentage of blood leaving your heart each time it contracts.

When the heart beats, it contracts or squeezes and then relaxes. During heart contraction, it pushes the blood within the pumping chamber  out. When your heart relaxes, the chambers or ventricles refill with blood. No matter how forceful the contraction, it doesn’t empty all of the blood out of a ventricle. The term “ejection fraction” refers to the percentage of blood that’s pumped out of a filled ventricle with each heartbeat.

A normal LV ejection fraction is 55 to 70 percent. The ejection fraction may decrease if:

  • A heart attack has damaged the heart muscle such that it cannot forcefully contract
  • The valves of the heart are not working properly
  • Blood pressure has been uncontrolled  for a long period of time
  •  Weakness of the heart muscle, such as dilated cardiomyopathy

I get great gratification in this patient announcing this for another reason. I have a history of arguing with cardiologist about teaching patients their heart’s condition by reading their medical reports with them. As part of the intake to cardiac rehabilitation the charts are reviewed so both the patients and the clinicians have a solid understanding of their heart condition and the plan to manage the heart condition. Many patients enter rehabilitation with their last echo cardiogram or other studies showing the patient has a severely reduced ejection fraction. Some people will always have a reduced ejection fraction and others will recover depending on the severity of condition. A late presenting large heart attack may have permanently reduced pumping ability of the heart, where as a stent placed early in a heart attack may improve within a very short time. Other conditions slowly change over time, getting better or worse these include hearts that have cardiomyopathy, or pacemakers.

I believe heart patient’s understanding of their ejection fraction an important part of managing their health. The cardiologist was worried I would scare his patients.  The cardiologist  felt people would psychologically not improve if they knew their ejection fraction was low.  Many people with a reduced ejection fraction will not have any significant functional limitations or symptoms. I have worked with people with ejection fractions in the 8-10% who can function pretty normal including performing weight or resistance training exercises. On the other hand some folks with an ejection fraction of 30-40% can feel symptoms of fatigue or shortness of breath with mild exertion.

For many through building structured exercise they can improve the muscular strength of their body thus reducing the effort the heart has to work to meet the demands for oxygenated blood. Exercise does improve the ejection fraction in many studies, but if it doesn’t it still  improves the functional ability and quality of life of most individuals. Cardiac Rehabilitation programs often will note  an improvement in patients  ejection fraction. It is typical to undergo echo cardiogram studies approximately three month post intervention or event. I believe it is more of an insurance reimbursement issue which makes  most scheduling occur at 3 months post, but also gives the heart time to recover and medical management to be fully effective, and this is typically how long a cardiac rehabilitation program lasts.

When the overeager patient comes in and wants to give themselves a workout equivalent to a stress test on their first few sessions  of cardiac rehabilitation to prove to themselves they are ok,  we will  use information such as their ejection fraction to determine  and educate how much effort they should safely perform.  Then there is the  scared patient who has been living with a reduced ejection fraction and had short of breath and  gets a bi-ventricular pacemaker  the cardiac rehabilitation staff encourages them to increase their workloads as their ejection fraction is likely much improved and now can feel safe pushing the intensity. Reviewing this information with you healthcare provider can help you to understand your heart and any limitations it may have.

Read more about ejection fraction here

20 thoughts on “Do You Know Your Heart’s Ejection Fraction?

  1. Pingback: Do You Know Your Heart's Ejection Fraction? | Heart diseases and Heart Conditions |

  2. I can relate to the importance of knowing your ejection fraction. Long story short: I had heart attack at age 46 (I will turn 64 next month) and underwent quadruple bypass surgery. I had two angioplasties over the next two years, then was relatively symptom free until age 59. I had a stent put in 2007, but by 2009 felt horrible with no energy, frequent angina, and shortness of breath. Echocardiogram revealed ejection fraction of 15, which dropped to 13 over the next year. I was diagnosed with Congestive Heart Failure and put on diuretics in addition to my normal heart meds. In August of 2012 I was in pretty bad shape. A severe blockage was found in my subclavian artery (left) and my carotid artery (left) was 90 percent blocked. I had a stent put in the subclavian in August and carotid artery surgery in late September. Over the subsequent months I gradually felt better. Most recent echo revealed my ejection fraction to now be at 55. Just incredible! I was treated with meds, light exercise, and loads and loads of prayer.

    • So glad to hear the nice improvement in your EF! Your story does remind us how aggressive heart disease can be, especially when it present in young folks. It does take a combination of things, medications – ACE inhibitors make a big difference, exercise, the power of prayer, a good medical team, and knowing your body and it’s symptoms. Keep up the good work, and fighting the long hard battle.

  3. Pingback: Do You Know Your Heart's Ejection Fraction? | Cardiac Diet Meal and Menu Plan |

  4. Hello, a few month shy of turning 48yr (I am now 53) I experienced a Myocardial Infarction, liver & kidney failure complicated by sudden death, This was at home and I was gone for 6 minutes, before being resuscitated, so the report says, This was followed by several “Code Blue”s in the hospital. This was followed by 1 days in a coma, 1 week full life support but out of coma. It to weeks before I could walk and months of therapy for motor, cognitive and speech skills. I believe I would not be alive and doing as good as I am if it were not for faithful God and a praying wife. I was left with a damaged heart and a bit of brain damage affecting memory and thinking I am getting better but it is still an issue.. But to the point of this response . My LVEF has hovered between 33% to 40%. It was last tested at 40% I have not experience chest pain, but I do get head pain, this was the only symptom the night I mentioned. I get the pain when I exert a little and under stress. I have a weight limit 20lbs (I was to I could lift a little more, but not to push it). I also have a BPM limit of 125bpm. I am on coreg and plavix and lovaza. I walk a little stopping when I get the pain in neck and head. My question to you is what type of exercise can I do with those restrictions?

    • Amazing survivor story. I would first off recommend you find a cardiac rehabilitation program in your area where you can get personalized exercise prescriptions and counseling. If one is not available work within your restrictions. The Coreg will surpress your heart rate so you might find you can do quite a bit and still be within the physicians recommended guidelines. A heart rate monitor would be helpful so you can easily watch your rates…I recommend Polar monitor with a chest strap. Always start out activity very very light. A warm up that feels like a waste of time, this prepares the heart and vasculature by dilating the vessels. Aerobic exercise – walking, biking, recumbent steppers, arm bikes. Build the time up first before adding intensity – or making the exercise harder. If you can build to 30 minutes of continuous movement that is great! Then gradually add a little resistance. The goal for you would be more to get regular continuous movement than to worry about pushing hard. You should be able to talk without being winded, and free of symptoms. Did you get that FREE of SYMPTOMS. If you do get symptoms slow down then rest until symptoms resolve. Be sure to report to your healthcare provider what activity level provokes the symptoms and how frequently you get them.

      Weights or resistance training with 1-10 lbs should be done 2-3 times per week. Pick several arm exercises, and work on building up the repetitions. start with 10 reps build to 30 or more. See this page for more information.

  5. Great post. I was checking continuously this blog and I’m impressed! Very helpful information particularly the last part 🙂 I care for such information a lot. I was seeking this particular info for a very long time. Thank you and best of luck.

  6. Hellow. I am 42 years old. On 2009 angioplast done for 90 % blocking. Again, restenting done at same stent on 2012. Now my LVEF is 34 % and not improving at all. Requesting suggsting what to do ?

  7. Sir.. My fathr went to bypass Surrgry.. Aftr tgt his ef increased 2% aftr tgt but frm last 6 mnth his ef detoriate abt 20% left with only 17% kindly suggest wat to do

  8. Hello, and good day out there.

    My official diagnose is UNS cardiomyopathy. It started two years ago (i was 28 y/o) with chest and side pain to which i got used untill woke up one morning all wet and with hardest pain i ever had in a chest and could not feel my left arm. The LV size was increased above 65 and EF was said to be around 35%. I recived ace inh and cardiloc, which in time was substituted with carvedexxon. I made a huge amount of Echoes and three MRI in a first year, all showing different results with EF flowing from 36% to 57%. The heart now returned to its normal size (which means that its not dilated cardimyopathy and that fact makes me more then happy).

    Anyway, i learned to always check metters of BP, pulse and pulpitations. Holters are clean and last stress i took showed vo2/kg 24.3 (6 months ago it was 20.1), but EF still stays low (between 45% and 50%) and im getting lost within all those diagnoses, tests and predictions.

    Im still on ace inhibitors and bisoprolol (althought the dosage is qurter of what is was when all this began..).

    I do feel fatigue and shorteness of breath from time to time, but not quite sure if it’s physiological or psycological..

    What can i do to help my EF grow higher apart from taking meds and quit smoking (its sad, but im still trying to work it out..) ?

  9. The ejection fraction improves in about 1/3 or cases, stays the same in about 1/3 and worsens in about 1/3. There is no way to know who’s will improve and who’s won’t. You are on the right medications, exercise regularly, talk to your physician about suplements such as CoQ10, and definitely stop all tobacco immediately. Make your exercise routine, keep it fun, join classes, consider a cardiac rehabilitation support group or phase 4 class. Be vigilant in watching for signs and symptoms such that you don’t have another event which damages the heart and decreases the EF. The low EF is not a death sentence, many people with lower than normal EF’s lead very vigorous lives without issues. Best wishes to you.

    • I was diagnoised with an EF of 10% and have seen all teh specialist. However i find it disheartening( mind teh pun) that a docotr would just say “you have a bad heart”. I just read 5 different comments on how EF can be improved through meds and prayer and exercise. So how come doctors are so negative when it comes to a diagnoses about EF?

    • Great question! Any readers out there want to take a stab at it? My take would be that the regulations and high stress of medicine and it’s politics, management, demands of the job lead to burn out which reflects in a physicians response to patients inquiries.

  10. Hi there! I’m a 23 y/o male. A year ago (July 2013), I was diagnosed with viral myocarditis which resulted in dilated cardiomyopathy. I had an EF of 22% at the time. I also experienced difficluty breathing through the nose. My FIRST DOCTOR said I also developed allergic rhinitis so I had to use nasal spray (no steroids) at times which made my heart work harder. She restricted my physical activities. I wasn’t allowed to go up stairs, exercise, drive, go to the mall because she says I might get sick, or even do household chores. I followed all her advices. Low salt, low fat diet etc. Fast forward to today (Oct 2014), my EF is still at 38%, I’m quite concerned that my heart’s EF is not yet near normal though I can function normally. I decided to see another physician. My SECOND DOCTOR tells me to exercise little by little, he also allowed me to drive, and do other things which were restricted by the first doctor. I guess his approach is much more aggressive than the first one. The first one’s approach was much much more conservative.

    I’m really concerned and scared at the same time for my heart’s health. Is it possible that the approach of my first doctor may have hindered my recovery since I wasn’t allowed to exercise much? That maybe the approach of my second doctor can help my heart to fully recover?

    Are there cases where the patient recovers fully even after a year from diagnosis? Hoping for your reply! I hope you could give me some advice. Thank you! 🙂

    • Often it takes a year to recover, that is one reason why most echo’s are at least 3 -6 months apart. Not knowing the full medical history makes it challenging to know if the first doctor was right or not. Anyway it cannot be changed and can only go forward. I have seen patients EF’s return slowly over years, however many plateau just below “normal”. Most importantly is how you feel if a lower EF doesn’t change how you feel for the worse this is great. I have worked with very very low EF patients who are energetic exercise at moderately intense levels and do great, then on the flip side some with near normal EF’s feel absolutely terrible, weak and short of breath. There is no prediction ability to tell which patient does better or worse based only on the EF number. I believe good mental health, a healthy diet, prudent exercise, adequate sleep and a good relationship with your physician can make all the difference in one’s recovery.

      I would recommend not looking back, keep building exercise slowly, and get back to living life.

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