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Systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF), is a type of heart failure in which the main chamber of the heart does not pump as effectively as it should. This can lead to symptoms such as fatigue, leg swelling, and shortness of breath.
This article discusses systolic heart failure and its symptoms, causes, and treatment.
Understanding Systolic Heart Failure
The heart acts as a pump to supply oxygen and nutrients throughout the body. The left ventricle is the main chamber of the heart that pumps blood to the body. Normally, the left ventricle pumps more than half of the blood it receives in each heartbeat.
The ejection fraction (EF) is a measure of the left ventricle's pumping efficiency and is the proportion of blood pumped out of the heart. An ejection fraction of 55%–60% or higher is normal, and means that 55%–60% of the blood in the left ventricle is pumped out with each heartbeat.
Although an ejection fraction below 55% is abnormal, an ejection fraction under 40% is considered heart failure with reduced ejection fraction (HFrEF), also known as systolic heart failure.
A low EF can cause reduced cardiac output. Cardiac output is the amount of blood the heart is able to pump out each minute.
Systolic Heart Failure Symptoms
- Shortness of breath
- Exercise intolerance
- Inability to lay flat due to difficulty breathing
- Waking up at night with spells of breathlessness
- Rapid heartbeat (palpitations)
- Decreased appetite and nausea
- Leg and ankle swelling
- Abdominal fullness (bloating)
What Causes Systolic Heart Failure?
Systolic heart failure has many causes, including:
- Coronary artery disease
- High blood pressure
- Alcohol or cocaine use
- Chemotherapy or radiation therapy
- Genetic inheritance
- Heart valve disorders, like mitral regurgitation
- Arrhythmias (heart rate or rhythm problem)
- Metabolic issues, such as thyroid disorders
- Nutritional deficiency, such as thiamine (Vitamin B1) deficiency
- Stress cardiomyopathy, also known as Takotsubo (heart muscle becomes suddenly weakened)
- Peripartum cardiomyopathy (heart muscle weakness that starts around the final month of pregnancy through several months after delivery)
Sometimes, the cause of heart failure is not known. This is considered idiopathic.
Diagnosing Systolic Heart Failure
Systolic heart failure is diagnosed with a noninvasive test called transthoracic echocardiography. This test involves an ultrasound that can generate pictures of the heart and evaluate the heart's pumping function (EF), as well as the valves and flow of blood.
Other tests to help determine the cause and complications of heart failure include:
- Blood tests, including blood counts, electrolytes, and kidney, liver, and thyroid function
- Electrocardiogram (records electrical signals in your heart)
- Stress testing such as a nuclear stress test
- Cardiac MRI (magnetic resonance imaging of the heart)
- Coronary angiography (X-ray imaging of blood vessels in the heart)
Managing systolic heart failure requires lifestyle changes and medications. Sometimes implantable devices can help.
In addition to medications, people with systolic heart failure should follow a low-salt diet and monitor their fluid intake. Weighing yourself daily can help you keep track of fluid overload.
Those with systolic heart failure should avoid excessive alcohol intake and stay away from other substances.
Systolic heart failure is a well-studied condition, and several medications have been shown to improve prognosis in people with this condition. Sometimes, the weakened heart muscle can even improve with medication.
The following are medications commonly used to treat systolic heart failure:
- Diuretics like Lasix (furosemide) or torsemide
- Beta-blockers, specifically Toprol XL (metoprolol succinate), Coreg (carvedilol), and bisoprolol
- Ace-inhibitors or angiotensin receptor blockers (ARBs)
- Neprolysin inhibitors, like in the combination pill Entresto (sacubitril and valsartan)
- Aldosterone antagonist like Aldactone (spironolactone)
- Vasodilators like Bidil (isosorbide dinitrate and hydralazine)
- SGLT2 inhibitors like Farxiga (dapagliflozin) and Jardiance (empagliflozin)
- Procoralan (ivabradine)
Note that treatment is individualized and some medications may not be tolerated in certain people.
Implantable Device Therapy
An implantable cardioverter defibrillator (ICD) is recommended for some people with low EF. An ICD is a small device placed under the skin in the chest, with wires that sit in the heart's chambers. ICDs monitor the heart's rhythm and deliver a "shock" of electricity to stop life-threatening arrhythmias.
Some people who have abnormal electrocardiogram and systolic heart failure can benefit from cardiac resynchronization therapy (CRT). CRT is a special type of ICD with an additional lead that helps it optimize the timing of the heart's contraction. CRT can help improve symptoms, and some people even see an improvement in their EF with this therapy.
Prognosis of Systolic Heart Failure
In general, a diagnosis of heart failure is serious, since it can cause life-threatening arrhythmias and organ failure.
Taking medications as prescribed, monitoring fluid status, and close follow-up with a healthcare provider can help people with heart failure stay out of the hospital and improve quality of life.
Advanced treatments and heart transplant are also options for those with very severe heart failure.
Coping With Heart Failure
Dealing with heart failure symptoms can be difficult, particularly when it impacts daily life. Exercise ability may be significantly limited, with some people having shortness of breath with minimal activity or even while at rest. In addition, leg swelling can become painful, and it can be hard to find shoes that fit.
Staying organized is very important. Consider investing in a pill sorter to keep track of all of the medications you are prescribed. Each morning, write down your weight, blood pressure, and any symptoms on a calendar and bring this to your healthcare provider visits.
For some, cutting back on salt can be a big help. Using other spices can help keep flavor in meals without the added salt.
As with any chronic condition, support from loved ones can help you cope. Many hospitals also offer support groups for people with heart failure.
Systolic heart failure is a serious condition in which the heart's main chamber is not pumping as effectively as it should. This causes symptoms of shortness of breath, fatigue, and leg swelling, and increases the risk of arrhythmias and organ failure. Several medications and devices can improve survival of people with systolic heart failure.
A Word From Verywell
A diagnosis of systolic heart failure is life-changing. It requires monitoring of your diet and remembering to take a handful of medications. Managing the symptoms of heart failure and side effects of medications can be overwhelming. Support from loved ones and healthcare providers can help you cope and live with the condition.