What Are The Treatments Available For Low Ejection Fraction?

A diagnosis of low ejection fraction, often referred to as heart failure with reduced ejection fraction (HFrEF), means your heart muscle isn't pumping as much blood out of its chambers as it should. While this can be a serious condition, a wide range of effective treatments are available to manage symptoms, slow the progression of heart failure, and improve your quality of life. Treatment is typically a multi-faceted approach, combining medications, lifestyle changes, and in some cases, medical devices or surgery.

The primary goals of treatment are to address the underlying cause of the weakened heart muscle, reduce the workload on the heart, prevent fluid buildup, and improve the heart's pumping efficiency. A cardiologist will create a personalized treatment plan based on the severity of your condition, your symptoms, and your overall health.

Key Treatment Categories for Low Ejection Fraction

Managing low ejection fraction involves a comprehensive strategy. Below are the core components of modern treatment plans, from foundational medications to advanced surgical interventions.

Medications: The Cornerstone of Treatment

Medications are the first line of defense and are essential for nearly everyone with a low ejection fraction. Different classes of drugs work in unique ways to support heart function.

• ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors): These drugs, such as lisinopril and enalapril, are often prescribed first. They work by relaxing and widening your blood vessels, which lowers blood pressure and makes it easier for your heart to pump blood throughout the body. This reduction in workload helps protect the heart from further strain.
• ARBs (Angiotensin II Receptor Blockers): If you cannot tolerate the side effects of ACE inhibitors (like a persistent cough), your doctor may prescribe an ARB, such as losartan or valsartan. They offer similar benefits by blocking the action of a chemical that narrows blood vessels, thereby easing the heart's workload.
• ARNIs (Angiotensin Receptor-Neprilysin Inhibitors): This is a newer class of medication that combines an ARB with a neprilysin inhibitor. The most common one is sacubitril/valsartan (Entresto). It not only reduces the strain on the heart but also helps the body get rid of sodium and water, further decreasing the heart's workload. ARNIs have been shown to be highly effective in improving outcomes for patients with HFrEF.
• Beta-Blockers: Medications like metoprolol, carvedilol, and bisoprolol are crucial. They work by slowing your heart rate and lowering blood pressure, which decreases the heart's demand for oxygen. Over time, beta-blockers can actually help the heart muscle recover some of its strength and improve ejection fraction.
• Aldosterone Antagonists: Also known as mineralocorticoid receptor antagonists (MRAs), drugs like spironolactone and eplerenone are types of diuretics. They help the body remove excess salt and water while retaining potassium. More importantly, they block a hormone that can cause scarring and stiffening of the heart muscle, helping to slow the progression of heart failure.
• SGLT2 Inhibitors (Sodium-Glucose Cotransporter-2 Inhibitors): Originally developed to treat type 2 diabetes, medications like dapagliflozin and empagliflozin have been found to be remarkably effective for heart failure, even in people without diabetes. They help reduce fluid in the body and have protective effects on the heart and kidneys, leading to fewer hospitalizations and improved survival.
• Diuretics ("Water Pills"): Drugs like furosemide (Lasix) help reduce fluid retention, a common symptom of heart failure. By helping your kidneys remove excess sodium and water, they relieve symptoms like swelling (edema) in your legs and ankles and shortness of breath caused by fluid in the lungs.

Medical Devices and Surgical Procedures

When medications and lifestyle changes aren't enough, or if specific underlying conditions exist, your doctor may recommend a device or surgical procedure to improve heart function and prevent dangerous complications.

• Implantable Cardioverter-Defibrillator (ICD): A low ejection fraction puts you at a higher risk for life-threatening abnormal heart rhythms (arrhythmias). An ICD is a small device implanted under the skin in your chest, with wires leading to your heart. It continuously monitors your heart's rhythm and, if it detects a dangerous arrhythmia, delivers an electrical shock to restore a normal heartbeat.
• Cardiac Resynchronization Therapy (CRT): Also known as a biventricular pacemaker, a CRT device is used when the heart's lower chambers (ventricles) are not beating in sync. This "dyssynchrony" makes the heart's pumping action inefficient. A CRT device sends tiny electrical impulses to both ventricles to make them contract at the same time, improving the overall pumping function and increasing the ejection fraction.
• Coronary Artery Bypass Graft (CABG) Surgery: If your low ejection fraction is caused by severe blockages in the arteries supplying blood to your heart (coronary artery disease), bypass surgery may be an option. A surgeon uses a blood vessel from another part of your body to create a detour around the blocked artery, restoring blood flow to the heart muscle.
• Heart Valve Repair or Replacement: A faulty or leaky heart valve can force the heart to work much harder, leading to a weakened muscle and low ejection fraction. Depending on the specific problem, a surgeon can either repair the existing valve or replace it with an artificial one, which can significantly improve heart function.
• Ventricular Assist Devices (VADs): For individuals with severe, end-stage heart failure, a VAD can be a life-saving option. This mechanical pump is surgically implanted to help the weakened ventricle pump blood to the rest of the body. It can be used as a "bridge to transplant" (while waiting for a donor heart) or as a long-term treatment (destination therapy).
• Heart Transplant: A heart transplant is the ultimate treatment for end-stage heart failure when all other options have failed. It involves replacing the diseased heart with a healthy donor heart. This is a major operation reserved for the most severe cases who meet specific health criteria.

Crucial Lifestyle and Dietary Changes

Your daily habits play a massive role in managing low ejection fraction. These changes work alongside medical treatments to reduce stress on your heart and manage symptoms.

• Sodium Restriction: Limiting salt intake is one of the most important lifestyle changes. Consuming too much sodium causes your body to retain fluid, which increases blood volume and makes your heart work harder. Most doctors recommend consuming less than 2,000 milligrams of sodium per day.
• Fluid Restriction: In some cases, your doctor may ask you to limit your daily fluid intake. This helps prevent fluid overload, which can lead to swelling and shortness of breath. Your healthcare team will provide specific guidelines on how much fluid you should consume each day.
• Doctor-Approved Exercise: Regular physical activity is vital for strengthening your heart and improving overall cardiovascular health. A cardiac rehabilitation program can help you learn how to exercise safely. Activities like walking, cycling, or swimming can improve your energy levels and heart function.
• Quitting Smoking and Limiting Alcohol: Smoking damages blood vessels and reduces the amount of oxygen in your blood, forcing your heart to work harder. Alcohol can be directly toxic to the heart muscle and can worsen heart failure. Quitting smoking and limiting or avoiding alcohol are critical steps.

Understanding Ejection Fraction and Why It Matters

To fully appreciate the treatments, it's helpful to understand what ejection fraction (EF) actually is. In simple terms, ejection fraction is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. The left ventricle is the heart's main pumping chamber, responsible for sending oxygen-rich blood to the rest of the body.

A normal EF is typically between 50% and 70%. This means that with each heartbeat, 50% to 70% of the blood in the left ventricle is pushed out. A low ejection fraction, or HFrEF, is generally considered to be 40% or less. This indicates that the heart muscle has been weakened and cannot pump blood effectively. This inefficiency can be caused by various conditions, such as a prior heart attack that damaged the heart muscle, long-standing high blood pressure, or diseases of the heart muscle itself (cardiomyopathy). Monitoring EF is a key way for doctors to diagnose heart failure, track its progression, and determine how well treatments are working.

Common Questions About Managing Low Ejection Fraction

Receiving a diagnosis of low EF often leads to many questions. Here are answers to some of the most common ones.

Can Ejection Fraction Be Improved Naturally?

While medical treatments are the foundation for improving ejection fraction, lifestyle changes play a powerful supporting role and are essential for success. The term "naturally" in this context refers to non-pharmacological and non-surgical interventions. Adopting heart-healthy habits can significantly reduce the strain on your heart, which can, in some cases, help the EF number improve over time when combined with proper medical care.

Consistent, moderate exercise, as recommended by your doctor, is one of the most effective strategies. Exercise strengthens the entire cardiovascular system and can help the heart muscle become more efficient. Similarly, a strict low-sodium diet prevents fluid retention, directly reducing the heart's workload. Managing stress through techniques like meditation or yoga, getting adequate sleep, and maintaining a healthy weight all contribute to a better environment for your heart to function. These "natural" approaches are not a replacement for medication but are a critical part of the comprehensive plan to manage the condition.

What are the Main Causes of a Low Ejection Fraction?

A low ejection fraction is not a disease in itself but rather a sign of an underlying problem that has weakened the heart muscle. The most common cause is coronary artery disease (CAD), where plaque buildup narrows the arteries supplying blood to the heart. A heart attack is often a direct consequence of CAD and can cause permanent damage to a portion of the heart muscle, reducing its ability to pump.

Other significant causes include long-term, uncontrolled high blood pressure, which forces the heart to work too hard for too long, eventually leading to muscle weakening. Faulty heart valves, whether leaky or narrowed, can also overwork the heart. Additionally, conditions known as cardiomyopathy—diseases of the heart muscle itself—can be a cause. These can be inherited, caused by viral infections, or related to excessive alcohol consumption. Identifying the root cause is a crucial step for your doctor in determining the most effective treatment path.

What Symptoms Should I Watch For With Low Ejection Fraction?

The symptoms of low ejection fraction are primarily caused by two things: the heart's inability to pump enough oxygen-rich blood forward to the body's tissues, and the backup of blood into the lungs and other parts of the body. One of the most common symptoms is shortness of breath, especially during physical activity or when lying down flat. This happens because fluid can accumulate in the lungs (pulmonary congestion).

Another key symptom is persistent fatigue and weakness, as your muscles and organs aren't receiving enough oxygen to function optimally. Swelling (edema) in the legs, ankles, and feet is also very common, caused by fluid buildup due to poor circulation and kidney function. Other signs can include a rapid or irregular heartbeat, a persistent cough or wheezing, and a reduced ability to exercise. Paying close attention to these symptoms and reporting any changes to your doctor is vital for managing the condition effectively.

A Comprehensive Approach to Treatment

Treating low ejection fraction is a long-term commitment that requires a partnership between you and your healthcare team. The strategy is rarely about a single solution but rather a combination of medications to support heart function, lifestyle adjustments to reduce strain on the heart, and potentially advanced devices or procedures to correct underlying issues. By adhering to your prescribed treatment plan, you can effectively manage symptoms, slow the progression of heart failure, and lead a fuller, more active life.

For More Information

To learn more about heart failure and its management, you can visit these reputable sources:

• American Heart Association - Heart Failure
• Mayo Clinic - Heart Failure