Your Heart’s Power: Ejection Fraction Explained

I remember a patient, let’s call him Mr. Roberts, coming into the clinic. He was a robust man, always had a story to tell about his fishing trips, but lately, he’d been getting breathless just walking to his mailbox. “Doc,” he said, his voice a little strained, “I just don’t feel like myself. I’m tired all the time.” After a few checks and listening carefully to his story, we started to talk about something called ejection fraction. It sounded a bit technical to him at first, but it’s really a key way we look at how well your heart is doing its main job: pumping blood. If you’ve heard this term from your doctor, or if you’re just curious about your heart’s health, let’s chat about what it all means.

What Exactly is Ejection Fraction?

Think of your heart as a super-efficient, two-sided pump. With every single beat, it pushes blood out to the rest of your body, delivering all that vital oxygen and nutrients. Ejection fraction (EF) is simply a measurement, expressed as a percentage, that tells us how much blood the main pumping chamber of your heart – usually the left ventricle – pushes out with each squeeze.

Imagine your left ventricle as a small, muscular balloon. It fills up with oxygen-rich blood that has just returned from the lungs. Then, squeeze, the heart muscle contracts and pumps a certain amount of that blood out into the aorta, the main artery that sends it to the rest of your body. The EF is the percentage of the blood that was in the ventricle that gets “ejected” with that squeeze. It’s a bit like this:

1. Blood comes into the heart’s top chambers (the atria).
2. Between heartbeats, the ventricles relax and fill with that blood.
3. When your heart beats again, the ventricles contract, and whoosh, a good portion of that blood is pumped out.

It’s important to know that a healthy heart doesn’t pump out all the blood from the ventricle with each beat. It’s normal for a certain amount to remain. The EF tells us if the proportion being pumped out is in a healthy range.

Understanding Your Ejection Fraction Numbers

For most folks, a healthy heart has a left ventricular ejection fraction (LVEF) somewhere between 50% and 70%. This means that with each heartbeat, 50% to 70% of the blood in your left ventricle is sent on its way. Knowing your EF is very important because it gives us a good snapshot of your heart’s pumping strength. If it’s lower than normal, it can be a sign that the heart muscle has been weakened or damaged, which is a key feature of a condition called heart failure.

Here’s a breakdown of what the numbers generally mean:

Sometimes, and this can be a bit confusing, people can have all the classic symptoms of heart failure even with a normal ejection fraction (above 50%). We call this heart failure with preserved ejection fraction (HFpEF). In this case, the pump muscle itself might be strong, but the chamber has become stiff and can’t relax properly to fill with enough blood in the first place. So, even though it pumps out a normal percentage, the total amount of blood being delivered to the body is still reduced.

Signs You Might Have a Low Ejection Fraction

If your EF is low and your heart is struggling to pump enough blood to meet your body’s needs, you might start to feel it. Some common signs and symptoms of heart failure include:

• Feeling unusually tired, weak, or fatigued (this is often one of the first and most persistent signs).
• Shortness of breath (dyspnea), especially when you’re active or when you lie down flat at night.
• Your heart fluttering, racing, or pounding (palpitations).
• Swelling (edema) in your legs, ankles, feet, or belly from fluid retention.
• A persistent cough or wheezing, sometimes with white or pink blood-tinged phlegm.
• Needing to urinate more often at night.
• Feeling nauseous or a loss of appetite.
• Difficulty concentrating or feeling confused, sometimes called “brain fog.”

These symptoms can be subtle at first, or they can come on more noticeably. It really varies from person to person.

How Do We Figure Out Your Ejection Fraction?

If you’re having symptoms that make us think about your heart function, or if you have a condition that puts you at risk (like a past heart attack, known coronary artery disease, or if you’re undergoing certain chemotherapy treatments that can affect the heart), we’ll likely want to measure your EF. The most common, easiest, and most widely available way we do this is with an echocardiogram. You’ve probably heard of it – it’s an ultrasound of your heart. It’s completely painless, uses sound waves, and gives us a really good look at your heart’s structure, valves, and how the walls are squeezing. Sometimes, we might use other tests too, like a Cardiac MRI, a Cardiac CT scan, or a nuclear scan (MUGA scan) for a different view.

What Can We Do If Your Ejection Fraction is Low?

Okay, so you’ve got the number. What now? Well, the good news is there’s a lot we can do. Our main goal is to treat the underlying reason why your EF is low and to help your heart work better and more efficiently. This often involves a multi-pronged approach to managing heart failure.

1. Medications: There are some fantastic medications available that are the cornerstone of treatment for HFrEF. These can help relax blood vessels, reduce strain on the heart, help your heart pump more efficiently, and get rid of excess fluid.
2. Lifestyle Adjustments: These are huge! Things like eating a heart-healthy diet (especially watching your salt and fluid intake), getting regular, gentle exercise (we can guide you on this, often through a cardiac rehab program), maintaining a healthy weight, managing stress, and definitely quitting smoking are all critical.
3. Treating Underlying Conditions: If high blood pressure is the culprit, we’ll work hard to get that under control. If it’s a blocked coronary artery or a leaky valve, sometimes those need specific attention with procedures.
4. Devices: For some folks with a very low EF and specific electrical patterns in their heart, a special type of pacemaker (like a biventricular pacemaker for cardiac resynchronization therapy) or an implantable cardioverter defibrillator (ICD) to protect against dangerous arrhythmias can be very helpful.

We’ll look at your specific situation, your EF number, your symptoms, and your overall health to figure out the best plan for you. And we’ll keep an eye on that EF with repeat tests to see how you’re responding to treatment.

You’re not alone in this. If you have concerns about your heart or your ejection fraction, please talk to us. We’re here to help you understand what’s going on and to walk with you on the path to feeling better. It’s a journey, and we’ll take it one step at a time.