Heart failure with reduced ejection fraction (HFrEF) is a condition where the heart muscle becomes weakened and cannot pump blood efficiently. This results in a decreased ejection fraction (EF), typically defined as an EF of ≤40%.
Understanding Ejection Fraction (EF)
Ejection fraction is a measurement of the percentage of blood the left ventricle pumps out with each contraction. A normal EF ranges from 50% to 70%, while an EF below 40% is classified as reduced ejection fraction (HFrEF).
Key Factors Affecting EF
- Myocardial Infarction (Heart Attack)
- Cardiomyopathy
- Valve Disease
- Hypertension
- Diabetes Mellitus
Causes of Heart Failure with Reduced Ejection Fraction
The underlying causes of HFrEF often involve conditions that damage or weaken the heart muscle. Common causes include:
- Ischemic Heart Disease: Blockages in the coronary arteries reduce blood supply to the heart.
- Hypertension: Prolonged high blood pressure increases heart workload.
- Myocardial Infarction: Scar tissue from heart attacks weakens heart function.
- Valvular Heart Disease: Damaged valves lead to inefficient blood flow.
- Cardiomyopathy: Genetic or acquired disorders affecting heart muscle structure.
Symptoms of HFrEF
Symptoms often develop gradually but can worsen if untreated. Key symptoms include:
- Shortness of breath (dyspnea)
- Fatigue and weakness
- Swelling in legs, ankles, and feet (edema)
- Rapid or irregular heartbeat
- Persistent cough or wheezing with white or pink mucus
- Reduced ability to exercise
Diagnosis of Heart Failure with Reduced Ejection Fraction
A combination of medical history, physical examination, and diagnostic tests are required to confirm HFrEF:
Diagnostic Tools
- Echocardiogram: Measures EF and evaluates heart structure.
- Electrocardiogram (ECG): Identifies heart rhythm abnormalities.
- Chest X-ray: Detects fluid buildup or heart enlargement.
- Blood Tests: Identifies biomarkers like B-type natriuretic peptide (BNP).
- Cardiac MRI: Offers detailed imaging of heart tissue.
Treatment for Heart Failure with Reduced Ejection Fraction
Effective HFrEF management combines lifestyle changes, medications, and sometimes devices or surgical interventions.
Medications
- ACE Inhibitors (e.g., Enalapril, Lisinopril): Reduce blood pressure and improve heart function.
- Beta-Blockers (e.g., Metoprolol, Carvedilol): Lower heart rate and improve survival.
- Aldosterone Antagonists (e.g., Spironolactone): Help prevent fluid retention.
- SGLT2 Inhibitors (e.g., Empagliflozin): Shown to reduce heart failure hospitalization.
- Diuretics: Relieve fluid buildup and reduce swelling.
Devices and Surgical Interventions
- Implantable Cardioverter Defibrillator (ICD): Prevents sudden cardiac death.
- Cardiac Resynchronization Therapy (CRT): Improves heart coordination.
- Heart Transplant: Reserved for severe, end-stage heart failure.
Lifestyle Management for HFrEF Patients
Lifestyle adjustments play a vital role in managing HFrEF:
- Maintain a low-sodium diet to reduce fluid retention.
- Engage in moderate physical activity as prescribed.
- Monitor weight changes to detect fluid buildup.
- Avoid alcohol and smoking to reduce cardiac stress.
Complications of Heart Failure with Reduced Ejection Fraction
If untreated, HFrEF may lead to serious complications:
- Pulmonary Edema: Fluid accumulation in the lungs.
- Arrhythmias: Irregular heart rhythms increasing the risk of stroke.
- Kidney Damage: Reduced blood flow impairs kidney function.
- Liver Congestion: Blood pooling in the liver causes swelling.
Prognosis and Outlook
With appropriate treatment, many individuals with HFrEF can manage their symptoms effectively. Regular medical follow-ups, medication adherence, and healthy lifestyle choices can significantly improve quality of life and survival rates.
Frequently Asked Questions:
What is the primary cause of HFrEF?
The leading cause is often ischemic heart disease resulting from coronary artery blockages or heart attacks.
Can HFrEF be reversed?
While HFrEF cannot typically be fully reversed, treatment can improve symptoms and enhance heart function.
How is ejection fraction calculated?
EF is calculated using echocardiography by measuring the percentage of blood pumped out during each heartbeat.
What foods should HFrEF patients avoid?
High-sodium foods, processed meats, and excessive alcohol should be limited to prevent fluid retention and high blood pressure.
Is exercise safe for HFrEF patients?
Yes, light-to-moderate exercise under medical supervision is beneficial for improving cardiovascular health.
