How to calculate cardiac ejection fraction. What is cardiac ejection fraction?

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. Important diagnostic value has an indicator of cardiac output, the norm of which indicates a sufficient amount of blood ejected into the aorta, and a deviation indicates impending heart failure.

Cardiac ejection fraction assessment

When a patient comes to the clinic with complaints of pain in the chest, 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:

• heartache;
• 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 enters, then cardiac output is 60%.

The work of the left ventricle is considered indicative, since from the left part of the heart muscle blood enters the systemic circulation. If malfunctions in the left ventricle are not detected in time, there is a risk of heart failure. Reduced rate 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.

1. 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.
2. Simpson's formula. The main difference is the possibility of getting all sections into the cut of the circle. The study is more revealing; it requires modern equipment.

Data obtained using two different formulas may differ by 10%. The data is indicative for the diagnosis of any disease of cardio-vascular 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%;
• To irreversible consequences leads to a decrease in the indicator of less than 35%;
• 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

Normally, more blood passes through, regardless of whether the heart is this 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%, reduced rate read 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 figure reaches 80% in trained people, in particular athletes, people leading a healthy, active lifestyle.

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

Even if the body is not affected by external irritating factors, then it is guaranteed that 50% of the blood will be pushed out 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.

Causes of reduced cardiac ejection fraction

The following pathologies lead to a decrease in cardiac output:

• cardiac ischemia;
• myocardial infarction;
• heart rhythm disturbances (arrhythmia, tachycardia);
• cardiomyopathy.

Each pathology of the heart muscle 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 lead 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,);
• myocardial dystrophy;
• cardiomyopathy;
• congenital pathologies, violation of the structure of the organ;
• vasculitis;
• vascular pathologies;
• hormonal imbalances in the body;
• diabetes;
• 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;
• heartache;
• 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;
• 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.

1. Cardiac output, normal 55-60%;
2. The size of the atrium of the right chamber, the norm is 2.7-4.5 cm;
3. Aortic diameter, normal 2.1-4.1 cm;
4. The size of the atrium of the left chamber, the norm is 1.9-4 cm;
5. Stroke volume, norm 60-100 cm.

It is important to evaluate not each indicator separately, but the overall clinical picture. If there is a deviation from the norm upward or downward of 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 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. A mandatory part of treatment is taking 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 deficiency.

Heart failure is treated not only with pills. Patient must monitor drinking regime, the daily volume of liquid 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. For arrhythmia can be installed artificial driver hearts. 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.

1. Active lifestyle.
2. Classes .
3. Proper nutrition.
4. Rejection of bad habits.
5. Rest on fresh air.
6. Relief from stress.

What is cardiac ejection fraction:

Liked? Like and save on your page!

17476 0

The high effectiveness of drugs that serve as the basis for the treatment of patients with CHF is confirmed by the results of large randomized trials (Table 1). The role of surgical methods treatment of such patients (Fig. 1). Great importance has an organization of outpatient monitoring. Although lifestyle measures are considered important, their impact on prognosis has not been proven.

Rice. 1. Treatment algorithm for patients with symptomatic HF and reduced EF. RCT - resynchronization therapy. LVEF - left ventricular ejection fraction.

Source: Dickstein K., Cohen-Solal A., Filippatos G. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) // Eur. Heart J. - 2008. - Vol. 29. - P. 2388-2422.

Table 1

Results of randomized controlled trials* of patients with symptomatic chronic heart failure and low left ventricular ejection fraction

Le- reading, researched dova- nie, year published cation	N	Death- ness V first year y pain- nykh, accepted waving pla- cebo/ con- role-playing group py	Previous I am more treat- tion **	Before- bav- le- nia To tera- FDI	OSR, % ***	Pre- until then puppy events tiy on 1000 pain- nykh, semi- cherished treat- tion ††
						Sme mouth	State option By CH	Sme mouth or Mr. tion By WITH N
CON- SEN- SUS, 1987	253	52	Spiro	Ena- lapril 20 mg 2 times in a day	40	146	-	-
SOLVD- T, 1991	25 69	15,7	-	Ena- lapril 20 mg 2 times in a day	16	45	96	108
CIBIS- 2, 1999	26 47	13,2	ACEI	Biso- prolol 10 mg 1 time in a day	34	55	56	-
MERIT- HF, 1999	39 91	11,0	ACEI	Metho- prolol 200 mg 1 time in a day	34	36	46	63
COPER- NICUS, 2001	22 89	19,7	ACEI	Karve- dilol 25 mg 2 times in a day	35	55	65	81
SENIOR S, 2005	21 28	8,5	ACEI + Spiro	Nebi- wolol 10 mg 1 time in a day	14	23	0	0
Val- HeFT, 2001	50 10	8,0	ACEI	Shaft- sartan 160 mg 2 times in a day	13	0	35	33 †††
CHARM- Alter- native 2003	20 28	12,6	BB	Kande- sartan 32 mg 1 time in a day	23	30	31	60
CHARM- Added 2003	25 48	10,6	ACEI + BB	Kande- sartan 32 mg 1 time in a day	15	28	47	39
RALES, 1999	16 63	25	ACEI	Spiro- nolac- tone 25-50 mg 1 time in a day	30	113	95	-
V- HeFT- 1, 1986	45 9	26,4	-	Hydra- lazin 75 mg 4 times in a day. ISDN 40 mg 4 times in a day	34	52	0	-
A- HeFT, 2004	10 50	9,0	ACEI + BB + spiro	Hydra- lazin 75 mg 3 times in a day. ISDN 40 mg 3 times in a day	-	40	80	-
GISSI- HF, 2008	69 75	9,0	ACEI + BB + spiro	Omega-3 poly- not on- saturated new fat- acidic lots 1 g 1 time in a day	9	18	0	-
DIG, 1997	68 00	11,0	ACEI	Digo- xin	0	0	79	73
HF- ACTION 2009	23 31	6,0	ACEI + BB + spiro	Physi- logical exercise opinions	11	0	-	-
COMPA- NION, 2004	92 5	19,0	ACEI + BB + spiro	PCT	19	38	-	87
CARE- HF, 2005	81 3	12,6	ACEI + BB + spiro	PCT	37	97	15 1	184
COMPA- NION, 2004	90 3	19,0	ACEI + BB + spiro	PCT- ICD	20	74	-	114
SCD- HeFT, 2005	16 76	7,0	ACEI + BB	ICD	23	-	-	-
R.E.M. ATCH, 2001	12 9	75	ACEI + spiro	Art- substantive ny LV	48	282	-	-

Notes.

* Excludes active-controlled studies (patients with preserved and low LV fraction were included in the CONSENSUS and SENIORS studies).

** In more than a third of patients, ACE inhibitor + beta blocker means that an ACE inhibitor is used in almost all patients, and a β-blocker in the majority. Most patients were also taking diuretics, and many were taking digoxin (with the exception of the DIG study). Spironolactone was used at the base dose in 5% of patients in the Val-HeFT study, 8% in MERIT-HF, 17% in CHARM-Added, 19% in SCD-HeFT, 20% in COPERNICUS, 24% in CHARM Alternative.

***Relative risk reduction in the primary endpoint. Hospitalization for CHF, patients hospitalized at least once due to worsening CHF; some patients were hospitalized several times.

† Stopped early to assess benefit.

†† Individual studies could not be conducted to assess the effect of treatment on these outcomes.

††† Primary endpoint, which also included treatment of HF with IV medications for 4 hours or more without hospitalization or resuscitation after cardiac arrest (both added nonsignificant numbers).

Designations: BB - β-blocker; RST-D - RST device with defibrillator; СС - cardiovascular; hospitalization - hospitalization; ISDN - isosorbide dinitrate; op. - published; spiro - spironolactone; VHS - ventricular assist system.

Research. A-HeFT (African-American Heart Failure Trial) - Study of heart failure in African-Americans;

CARE HF (Cardiac Resynchronization-Heart Failure) - Cardiac resynchronization for CHF;

COPERNICUS (Carvedilol Prospective Randomized Cumulative Survival) - Study on the use of carvedilol in patients with severe CHF;

CIBIS (Cardiac Insufficiency Bisoprolol Study) - Study on the use of bisoprolol in patients with CHF;

COMPANION (Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure) - Comparison drug treatment, cardiac stimulation and defibrillation for CHF;

CONSENSUS (Cooperative North Scandinavian Enalapril Survival Study) - Scandinavian study on the use of enalapril in patients with severe heart failure;

DIG (Digitalis Investigation Group) - Research on the use of digoxin;

GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico - Heart Failure) - Italian group for the study of MI survivors with HF;

HF-ACTION (Heart Failure- A Controlled Trial Investigating Outcomes Exercise TraiNing) physical exercise on outcomes;

MERIT-HF (Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure) - A study on the use of a sustained-release form of metoprolol in the treatment of patients with CHF;

RALES (Randomized Aldactone Evaluation Study) - Study of the effectiveness of spironolactone (aldactone♠) in complex treatment patients with severe CHF;

REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) - Randomized trial of the use of mechanical assist systems for the treatment of CHF;

SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure) - Study of the effect of nebivolol on outcomes and readmission in elderly patients with CHF;

SOLVD-T (Studies of Left Ventricular Dysfunction Treatment) - A study on the use of enalapril in the treatment of patients with LV dysfunction and clinically significant CHF;

V-HeFT (Vasodilator Heart Failure Trial) - Study of the use of vasodilators in CHF;

Val-HeFT (Valsartan Heart Failure Trial) - Study of the use of valsartan in heart failure.

Modified (with permission): McMurray J.J., Pfeffer M.A. Heart failure // Lancet. - 2005. - Vol. 365. - P. 1877-1889.

John McMurray, Mark Petrie, Karl Swedberg, Michel Komajda, Stefan Anker and Roy Gardner

Heart failure

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 a contractile movement, it releases a certain amount of it into 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 it is

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. For minor violations, this situation can be corrected with 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 use special programs, which 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 ultrasonography organ.

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 between 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, 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.

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 the right side of the abdomen. This is noted because stagnation in the vessels of the liver, 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, antihypertensive drugs are prescribed and surgical correction vices.

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

To heartily vascular system not 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, as complementary therapy Statins may be used 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.
• To refuse from 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 in case of violation heart rate.
• 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.

Mostly this therapy is aimed at eliminating symptoms and maintaining the functioning of organs. 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.

1. 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.
2. 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.
3. 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 is used to thin the blood. red clover, sweet clover, meadowsweet, hawthorn, broom.

Sedatives 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 the onset of 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%, then the possibility fatal outcome is in the range of 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 indicator, it is necessary to find the cause of the pathology and organize adequate treatment. If this is not done, the patient is at risk of developing heart failure and death.

Before diagnosing a patient with chronic heart failure, the doctor conducts diagnostics with the obligatory determination of such an indicator as the ejection fraction. It reflects the amount of blood that the left ventricle pushes into the lumen of the aorta at the time of its contraction. That is, through such a study it is possible to find out whether the heart is effectively coping with its work or whether there is a need to prescribe cardiac medications.

Norm of PV indicator

To assess the work of the heart, namely the left ventricle, the Teicholtz or Simpson formulas are used. It must be said that it is from this section that blood enters the general circulation and, with left ventricular failure, most often develops clinical picture heart failure.

The closer this indicator is to the norm, the better the main “motor” of the body contracts and the more favorable the prediction for life and health. If the obtained value is much less than normal, then we can conclude that internal organs do not receive the required amount of oxygen and nutrients with blood, which means the heart muscle needs to be supported somehow.

The calculation is made directly on the equipment on which the patient is examined. In modern ultrasound diagnostic rooms, preference is given to the Simpson method, which is considered more accurate, although the Teicholz formula is used no less often. The results of both methods may differ by up to 10%.

Ideally, the ejection fraction should be 50–60%. According to Simpson, the lower limit is 45%, and according to Teicholz - 55%. Both methods are quite different high level information content regarding the ability of the myocardium to contract. If the obtained value fluctuates between 35–40%, they speak of advanced heart failure. And even lower rates are fraught deadly consequences.

Reasons for decreased EF

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

1. Cardiac ischemia . At the same time, the blood flow through coronary arteries decreases.
2. History of myocardial infarction. This leads to the replacement of normal heart muscles with scars that do not have the necessary ability to contract.
3. Arrhythmia, tachycardia and other ailments that disrupt the rhythm of the body’s main “motor” and conductivity.
4. Cardiomyopathy. It consists of enlarging or lengthening the heart muscle, which is caused by hormonal imbalance, long-term hypertension, heart defects.

Symptoms of the disease

The diagnosis of “reduced ejection fraction” can be made based on symptoms characteristic of of this disease. Such patients often complain of attacks of shortness of breath, both during physical exertion and at rest. Shortness of breath attacks can be triggered by long walking, as well as doing simple housework: washing floors, cooking.

Often attacks occur at night in a lying position. Loss of consciousness, weakness, fatigue and dizziness may mean that the brain and skeletal muscles are experiencing a lack of blood.

In the process of disruption of blood circulation, fluid retention occurs, which leads to the appearance of edema, and in severe cases it affects internal organs and tissues. A person begins to suffer from abdominal pain with right side, and stagnation of venous blood in the vessels of the liver can be fraught with cirrhosis.

These symptoms are characteristic of a decrease in the contractile function of the main “motor” of the body, but it often happens that the level of ejection fraction remains normal, so it is very important to be examined and have an echocardioscopy at least once a year, especially for people with heart disease.

An increase in EF to 70–80% should also be alarming, as this may be a sign that the heart muscle cannot compensate for increasing heart failure and seeks to throw as much blood concentration as possible into the aorta.

As the disease progresses, the LV performance indicator will decrease, and it is echocardioscopy in dynamics that will allow us to catch this moment. A high ejection fraction is typical for healthy people, in particular athletes, whose heart muscle is sufficiently trained and is able to contract with greater force than that of an ordinary person.

Treatment

It is possible to increase a reduced EF. To achieve this, doctors use not only drug therapy, but also other methods:

1. Prescribed drugs to improve contractility myocardium. These include cardiac glycosides, after which a noticeable improvement occurs.
2. To prevent the heart from being overloaded with excess fluid, it is recommended to follow a diet limiting table salt to 1.5 g per day and fluid intake to 1.5 liters per day. Along with this, diuretics are prescribed.
3. Organoprotective agents are prescribed that help protect the heart and blood vessels.
4. Decide on surgery. For example, they perform valve replacement, install shunts on coronary vessels, etc. However, an extremely low ejection fraction may be a contraindication to surgery.

Prevention

Prevention to prevent the development of heart disease has great value, especially in children. In the age of high technology, when most of the work is done by machines, as well as constantly deteriorating environmental living conditions and poor nutrition, the risk of developing heart disease increases significantly.

Therefore, it is very important to eat right, exercise, and be outdoors more often. It is this lifestyle that will ensure normal contractility of the heart and muscle fitness.

During an ultrasound examination of the heart, the state of the cardiovascular system is assessed not only by the size of the organ and its parts, but also by the parameters of cardiac hemodynamics. One such indicator is the ejection fraction. Read on to learn more about what it is and what the normal cardiac ejection fraction is.

What is cardiac ejection fraction

The efficiency of the heart is determined by the volume of blood it pumps into the great vessels at the moment of ventricular contraction. The more blood flows into the aorta, and from it into the arteries, blood supplying organs and tissues, the more oxygen and nutrients flow to the body's cells. It is important to understand that at the moment of systole, not all the blood in the organ cavity enters the vessels. The volume of blood remaining in the ventricles after their contraction is called end-diastolic volume (EDV).

Cardiac output (NE) – the amount of blood in ml ejected by the heart per unit of time. IN clinical practice SV is calculated in ml/min, i.e. This is the number of ml of blood released into the great vessels in 1 minute.

Cardiologists also distinguish the concept of stroke volume (SV) - the number of ml of blood ejected by an organ in one contraction. Knowing the stroke volume, you can easily calculate the approximate value of cardiac output: to do this, you need to multiply the stroke volume by the number of heartbeats per minute.

How to calculate cardiac output rate on ultrasound

When performing an ultrasonographic study of cardiac activity, the ejection fraction (EF) of the left ventricle is calculated - this is the percentage ratio of the volume of blood entering the aorta to the amount of blood remaining in the LV.

In other words, this is the ratio of stroke volume to EDV. For example, if at the time of diastole (myocardial relaxation) there was 100 ml of blood in the heart, and during systole (contraction) 75 ml of blood was expelled, then the EF rate will be 75%. The ultrasound scanner calculates this indicator automatically, then it is entered into the study protocol.

What does the ejection fraction mean?

Knowing the EF indicator, the cardiologist can assess the contractile function of the heart muscle. The more blood is expelled by the heart at the moment of contraction, the more efficiently the myocardium works and vice versa. Ejection fraction is one of the markers of heart failure. Based on the value of this parameter and its change during dynamic observation, one can:

• identify latent (asymptomatic) cardiac pathologies;
• monitor the progression of myocardial failure;
• evaluate the effectiveness of drug therapy;
• make a prognosis of the course of the disease.

Normal value of cardiac ejection fraction on ultrasound

On cardiac ultrasound, the ejection fraction is no less than 45% and no more than 75%. On average healthy person this figure at rest is 50%. When assessing the EF value, the doctor looks at what formula was used to calculate it, since the lower value of the indicator changes depending on this.

In newborns and infants, the normal cardiac ejection fraction is 60–80%. As the child grows, the indicator values ​​gradually decrease.

At physical activity the EF value increases to a maximum of 80–85%. This is determined by performing echocardiography with exercise. An increase in the value of the ejection fraction with an increase in the body's oxygen needs makes it possible to assess the functional reserves of the myocardium. This is an important diagnostic criterion when examining professional athletes and military personnel.

Features of the indicator

• The normal cardiac EF is the same for men and women. In older people, there is a decrease in ejection fraction due to age-related changes heart muscle.
• An indicator level in the range of 45–50% may be a variant of the norm and an individual feature. A fall below 45% is always a sign of pathology.
• An increase in the numerical indicators of cardiac ejection fraction is observed with an increase in the number of heartbeats.
• A drop in EF value below 35% is an indicator of irreversible changes in the heart muscle.

Causes and symptoms of a decrease in the indicator value

Detection of cardiac output by echocardiography of less than 45–50% is a sign of decreased myocardial contractility. This occurs in the following diseases:

Symptoms indicating a decrease in ejection fraction are associated with the development of heart failure in a person. The main ones:

• increasing shortness of breath. At first it appears only during physical activity, but then it also appears at rest;
• decreased resistance to physical activity;
• pain in the heart area, behind the sternum;
• cardiac edema. With increasing heart failure, the initially appearing pastyness of the legs in the second half of the day progresses to general swelling of the whole body;
• heart rhythm disturbances. As a rule, tachycardia develops. So, the heart tries to compensate for the drop in cardiac output.

Useful video

What is cardiac ejection fraction can be learned from this video.

Is it possible to treat low ejection fraction?

It is important to understand that low cardiac ejection fraction is not an independent disease. This is just a manifestation pathological processes, occurring in the cardiovascular system. Therefore, having discovered this symptom, the cardiologist must find out the cause of its occurrence.

Therapy prescribed by a doctor will be aimed at treating the underlying disease.

Monitoring the value of the ejection fraction serves as a way to determine the prognosis of the course of the disease. An EF drop below 35% is considered a poor prognostic sign.

Prevention of a decrease in cardiac ejection fraction is aimed at creating optimal conditions to maintain cardiovascular health. The main ones are: proper nutrition, weight loss, smoking cessation, adherence to a daily routine and regular physical activity.