The rate of blood ejection from the heart. Left ventricular ejection fraction of the heart: norms, reasons for low and high, how to increase

What is cardiac ejection fraction?

FVS is an indicator that is calculated using a special formula. The stroke volume of blood that enters the aorta after one contraction of the heart muscle is taken and its ratio is determined in accordance with the end-diastolic volume of the ventricle - the blood accumulated in the cavity during the period of relaxation.

The resulting value is multiplied by one hundred percent, which makes it possible to obtain final result. It is the percentage of blood that is pushed into the ventricle during systole according to the total volume of fluid it contains.

The calculation of the indicator is carried out using computer technology during ultrasonographic examination of the heart chambers. With the help of this diagnostic method Only the left ventricle is examined.

Ultrasonography makes it possible to determine the ability of the left ventricle to perform its functions, which are to ensure adequate blood flow in the body.

Video about what cardiac ejection fraction is.

Values: norm, deviations

If a person is at physiological rest, then the normal value of EF is a percentage. Significant physical activity in adults leads to an increase in the percentage. No further increase is observed. This is explained by the fact that the myocardium cannot eject all the blood from the ventricle, as this causes cardiac arrest.

Values: norm, deviations

In modern medicine, only the reduced indicator is assessed. This is the main criterion that allows us to determine the irrational functioning of an organ. When the indicator decreases, most patients are diagnosed with myocardial contractile failure. In this case, the fraction value is less than 45 percent.

With contractile insufficiency, risks arise not only for health, but also for human life. When there is insufficient blood supply to organs, their functioning is disrupted. Against this background, multiple organ dysfunction develops, which leads to death.

Reduced ejection volume is most often observed against the background of systolic failure. It is completely impossible to get rid of this pathological condition. If certain conditions occur, treatment is performed by an endovascular or vascular surgeon. A person’s gender has no influence on EF. In elderly patients, a physiological decrease in indicators occurs.

When EF decreases, we can talk about an individual norm. But, with a value of less than 45 percent, a pathological process is diagnosed. In a healthy person, the EF value may increase if the heart rate and blood pressure level increase. If radionucleide angiography is used to measure the indicator, then the norm is percent.

If a patient is diagnosed with an indicator of less than 35 percent, this indicates the occurrence of irreversible processes in the myocardium. In the first few years of a child’s life, EF standards are higher and amount to 100%.

Cardiac ejection fraction is a necessary indicator by which the prognosis of various cardiovascular diseases is determined.

Causes of heart weakness

A decrease in EF is diagnosed against the background of a variety of diseases. In most cases, pathology is diagnosed if chronic heart failure develops. This disease appears when:

1. Ischemic disease. With this disease, blood flow to the coronary arteries, which provide oxygen supply to the heart muscle
2. Myocardial infarction. In most cases, the pathology develops after transmural and large-focal infarctions. After this critical condition, the muscle cells of the organ are replaced by scar tissue. It cannot contract, which leads to the formation of post-infarction cardiosclerosis
3. Conduction and rhythm disturbances, which are often observed and are characterized by an acute course. Against this background, the muscle gradually wears out. Its contractions are irrational and irregular. In most cases, pathology is diagnosed during the occurrence of various pathological processes that lead to disruption of the organ.
4. Cardiomyopathies. With this disease, structural abnormalities occur in the configuration of the heart. They occur when the muscles of an organ are stretched or hypertrophied. The cause of this pathology may be a violation hormonal levels, long-term arterial hypertension, in which high blood pressure levels, organ defects, etc. are observed

A decrease in cardiac ejection fraction can be diagnosed against the background of a variety of cardiac diseases. That is why it is recommended to treat them promptly.

Diagnostics

Values: norm, deviations

The pathological process is characterized by the presence of corresponding signs. Thanks to the symptoms of the disease, doctors are able to make a correct and timely diagnosis.

Patients complain of pain in the right side of the abdomen. It can also increase in size, which is explained by fluid retention in the abdominal cavity.

This condition is observed with venous stagnation. If it is observed for a long period, the patient may develop cardiac cirrhosis of the liver.

Patients may experience shortness of breath not only during physical overload, but also during periods of rest. Patients claim that shortness of breath occurs when lying down, especially at night. In pathology, the development of swelling of the skin on the face, feet and legs is diagnosed.

Untimely treatment of the pathology leads to swelling of the internal organs, which is explained by impaired blood circulation in the vessels of the subcutaneous fat, which leads to stagnation of fluid in it.

A decrease in the ejection fraction of the heart causes frequent weakness and excessive fatigue, even when performing usual activities. In some patients, pathology was diagnosed with frequent occurrence of dizziness. In some cases, loss of consciousness was diagnosed. This is due to insufficient blood supply to the brain and skeletal muscles.

The disease may be accompanied by stool upset, as well as nausea and vomiting. Some people complain of blood in their stool. Periodically, impaired sensitivity in the limbs may be observed. With a long course of the pathology, a rapid decrease in body weight is observed. Patients report the appearance of pain in the heart area, which is characterized by varying degrees intensity.

The indicator is determined using an electrocardiogram. Patients are also prescribed an ultrasound examination. Thanks to these examinations, the degree of cardiac output is determined. Diagnostics does not require specific preparation and is highly informative.

Diagnosis of cardiac EF makes it possible to determine the severity of the pathology and develop the correct treatment tactics.

Treatment

Cardiac ejection fraction: treatment

Pathology therapy is carried out if EF is less than 45 percent. This condition indicates that the functionality of the heart muscle is reduced due to various diseases.

Therapy is aimed at stabilizing pathological changes in the early stages. In most cases, drug therapy is carried out using:

• Angiotensin converting enzyme inhibitors. With the help of this medicine, the nutrition of the heart tissue improves, and the peripheral arteries dilate. With regular use of medications, the performance of the heart muscles significantly increases, and the resistance of the myocardium to stress increases. Patients are recommended to take Ramipril, Enalapril, Captopril
• Beta blockers. Thanks to these drugs, the organ's need for oxygen and other nutrients is reduced. When using the medicine, the heart rate decreases and the processes of natural cell death decrease. It is recommended to take Metoporolol, Nebivol, Bisoprolol
• Aldosterone receptor antagonists. The action of the drugs is aimed at stabilizing the amount of electrolytes. During the treatment period, excess fluid is removed and the load on the organ is reduced. Patients are prescribed Eplerenone, Spironolactone
• Diuretics or diuretics. The drugs remove excess fluid from the body and reduce the volume load on the body. Recommended use of Indapamide, Torsemide, Hypothiazide
• Cardiac glycosides. The medicine improves the contractility of the heart muscles, increases conductivity in cases of impaired myocardial function. Patients are treated using Strophanthin, Digoxin
• Peripheral vasodilators. Medicines are prescribed to reduce the load on the organ and improve blood flow in the area of ​​the heart vessels. Patients are recommended to take Nitroglycerin, Apressin, Sodium nitroprusside
• Calcium channel blockers. Thanks to medications, the blood vessels of the heart dilate, and the quality of tissue nutrition also increases. Therapy is carried out with Nifedipine, Nimodipine, Verapamil
• Disaggregants. The drugs are recommended to be used to eliminate the possibility of clot formation. For the treatment of pathology, it is recommended to take Aspirin, Plavix
• Antirhythmic drugs. Medications relieve disturbances in the rhythm of myocardial contractions. Therapy is carried out with Diltiazem, Disopyramide, Amiodarone

In particularly severe cases, surgical intervention is recommended. Patients are fitted with electrical pacemakers or cardiovector defiblators if there are life-threatening abnormalities in the heart rhythm. In some cases, resynchronization therapy is used. With its help, contractions of the ventricles and atria are stimulated in various rhythms.

During the treatment of pathology, it is necessary to adhere to certain recommendations. The patient must be provided normal nutrition, which will fully satisfy the needs of his body. Also, the patient must strictly adhere to the daily routine and rest.

Treatment of reduced cardiac ejection fraction may involve the use of a variety of techniques. The choice of a specific therapeutic method is carried out only by a qualified specialist in accordance with the individual characteristics of the patient and the severity of the pathology.

Prevention

If the patient does not have a genetic predisposition, then he can fully regulate the fraction norm. In this case, he is recommended to follow certain prevention rules. A person should exercise every day. It is also recommended to consume foods that contain large amounts of iron.

In order to prevent pathology, it is necessary to quit smoking. A person should minimize the consumption of alcoholic beverages. An excellent preventative method is to follow healthy image life.

If possible, a person should go to aerobics several times a week. Diet food will eliminate the threat of pathology development. It is best to give preference to dishes that contain a minimum amount of salt. If you have a hereditary predisposition to the disease, it is recommended to avoid going to the gym.

EF of the heart is a severe pathological process that can cause death. The pathological process can develop in a variety of cardiac diseases. It is accompanied by certain symptoms, upon the appearance of which it is necessary to carry out a diagnosis, which will allow prescribing the optimal treatment regimen. To avoid pathology, its prevention must be carried out in a timely manner.

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Normal value of cardiac ejection fraction, deviations of the indicator

From this article you will learn about cardiac ejection fraction: the norm of the indicator, how it is calculated and what it shows. When a deviation in ejection fraction (EF) is dangerous, why does a pathological change appear. Symptoms of indicators going beyond normal limits, principles of treatment and prognosis.

Ejection fraction (EF) is the ratio of stroke volume (blood that enters the aorta during one contraction of the heart muscle) to the end-diastolic volume of the ventricle (blood that accumulates in the cavity during the period of relaxation, or diastole, of the myocardium). The resulting value is multiplied by 100% to obtain the final value. That is, this is the percentage of blood that the ventricle pushes out during systole from the total volume of fluid it contains.

The indicator is calculated by a computer during an ultrasonographic examination of the heart chambers (echocardiography or ultrasound). It is used only for the left ventricle and directly reflects its ability to perform its function, that is, to ensure adequate blood flow throughout the body.

Under conditions of physiological rest, the normal value of EF is considered to be 50–75%; during physical activity, healthy people it increases to 80–85%. There is no further increase, since the myocardium cannot eject all the blood from the ventricular cavity, which will lead to cardiac arrest.

In medical terms, only a decrease in the indicator is assessed - this is one of the main criteria for the development of a decrease in cardiac performance, a sign of myocardial contractile failure. This is indicated by an EF value below 45%.

Such insufficiency poses a great danger to life - a small supply of blood to the organs disrupts their functioning, which ends in multiple organ dysfunction and ultimately leads to the death of the patient.

Considering that the reason for the decrease in left ventricular ejection volume is its systolic failure (as is the outcome of many chronic pathologies of the heart and blood vessels), it is impossible to completely cure this condition. Treatment is carried out to support the myocardium and aimed at stabilizing the condition at one level.

Cardiologists and therapists are involved in monitoring and selecting therapy for patients with low ejection fraction. Under certain conditions, the assistance of a vascular or endovascular surgeon may be required.

Features of the indicator

1. The ejection fraction does not depend on the gender of the person.
2. With age, a physiological decline in this indicator is noted.
3. A low EF may be an individual norm, but a value of less than 45% is always considered pathological.
4. All healthy people have an increase in value with an increase in heart rate and blood pressure levels.
5. The normal indicator when measuring by radionucleide angiography is considered to be 45–65%.
6. The Simpson or Teicholz formulas are used for measurement; normal values, depending on the method used, range up to 10%.
7. A critical level of reduction of 35% or less is a sign of irreversible changes in myocardial tissue.
8. For children in the first years of life, higher rates of 60–80% are typical.
9. The indicator is used to determine the prognosis of any cardiovascular disease in patients.

Reasons for the decline

At the initial stages of any disease, the ejection fraction remains normal due to the development of adaptation processes in the myocardium (thickening of the muscle layer, increased work, restructuring of small blood vessels). As the disease progresses, the heart's capacity becomes exhausted, the contractility of muscle fibers becomes impaired, and the volume of blood ejected decreases.

Such disorders are caused by all influences and diseases that have a negative effect on the myocardium.

Acute myocardial infarction

Scar changes in cardiac tissue (cardiosclerosis)

Painless form of ischemia

Tachy and bradyarrhythmias

Ventricular wall aneurysm

Endocarditis (changes in the inner lining)

Pericarditis (heart sac disease)

Congenital disorders of the normal structure or defects (violation of the correct location, significant reduction in the lumen of the aorta, pathological connection between large vessels)

Aneurysm of any part of the aorta

Aortoarteritis (damage to the walls of the aorta and its branches by cells of their own immunity)

Thromboembolism of pulmonary vessels

Diabetes mellitus and impaired glucose absorption

Hormone-active tumors of the adrenal glands, pancreas (pheochromocytoma, carcinoid)

Stimulant drugs

Symptoms of a decrease in indicator

Low ejection fraction is one of the main criteria for cardiac dysfunction, so patients are forced to significantly limit their work and physical activity. Often, even simple housework causes a deterioration in the condition, which forces you to spend most of your time sitting or lying in bed.

Manifestations of a decrease in the indicator are distributed by frequency of occurrence from the most frequent to the rarer:

• significant loss of strength and fatigue from usual activities;
• breathing disorders such as an increase in frequency, up to attacks of suffocation;
• breathing problems worsen when lying down;
• collapsed states and loss of consciousness;
• changes in vision (darkening in the eyes, “spots”);
• pain syndrome in the projection of the heart of varying intensity;
• increased number of heart contractions;
• swelling of the legs and feet;
• fluid accumulation in chest and stomach;
• gradual increase in liver size;
• progressive weight loss;
• episodes of impaired coordination and gait;
• periodic decrease in sensitivity and active mobility in the limbs;
• discomfort, moderate pain in the projection of the abdomen;
• unstable stool;
• attacks of nausea;
• vomiting with blood;
• blood in stool.

Treatment if the indicator decreases

An ejection fraction of less than 45% is a consequence of changes in the functionality of the heart muscle against the background of progression of the underlying disease-cause. A decrease in the indicator is a sign of irreversible changes in the myocardial tissue, and there is no talk of the possibility of a complete cure. All therapeutic measures are aimed at stabilizing pathological changes at their early stages and improving the patient’s quality of life at a later stage.

The treatment complex includes:

• carrying out correction of the underlying pathological process;
• treatment of left ventricular failure.

This article is devoted directly to left ventricular ejection fraction and the types of its disorders, so further we will talk only about this part of the treatment.

Drug correction

Basic drugs

Improving cardiac tissue nutrition

Increasing myocardial resistance to stress

Reliable increase in the performance of the heart muscle

Decrease in heart rate

Reducing the processes of natural death of heart cells under conditions of increased work

Increasing the number of zones with active contraction in the myocardium

Removing excess fluid and reducing the load on the myocardium

Reducing the volume load on the myocardium

Increased conductivity in conditions of impaired myocardial function

Additional funds

Vascular protection in conditions of altered blood flow

Prevention of clot formation due to venous stagnation

Ancillary drugs

Improving blood flow in the heart vessels

Surgical correction

1. Installation of pacemakers or cardiovector defibrillators for life-threatening cardiac arrhythmias.
2. Resynchronization therapy - stimulation of contraction of the ventricles and atria at different rhythms (slowing down the contraction of the ventricles by creating an artificial heart block).

Non-drug correction

• Normalization of nutrition in accordance with the needs of the body to stabilize normal weight.
• Dosed but mandatory physical activity.
• Normalization of the work-rest regime.
• Psychotherapeutic assistance.
• Physiotherapy and reflexology.

Forecast

• If the left ventricular ejection fraction decreases, being in the range of 40-45%, the risk of death due to cardiac arrest is about 10-15%.
• A decrease to 35–40% increases this risk to 20–25%.
• A further decrease in the indicator exponentially worsens the prognosis for the patient's survival.

There is no complete cure for the pathology, but timely therapy can prolong life and maintain a relatively satisfactory quality of life.

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Cardiac output: norm and causes of deviation

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.

What is ejection fraction and why does it need to be assessed?

Cardiac ejection fraction assessment

When a patient comes to the clinic with complaints of heart pain, 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 entered the aorta, then cardiac output was 60%.

The work of the left ventricle is considered indicative, since from the left part of the heart muscle blood enters big circle blood circulation If malfunctions in the left ventricle are not detected in time, there is a risk of heart failure. A decreased cardiac output indicates an inability of the heart to contract. full force 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 into the slice of the circumference of all parts of the myocardium. 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%;
• a decrease in the indicator of less than 35% leads to irreversible consequences;
• a reduced rate may be an 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 the left ventricle, regardless of whether the heart is currently busy 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, it is guaranteed that 50% of the blood will be expelled 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 the brain.

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 disease blood flow decreases in the heart, 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 cardiomyopathy leads 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, small muscles are rebuilt blood vessels. 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 inflammatory diseases(pericarditis, myocarditis, endocarditis);
• 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 lower limbs.

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 stool;
• 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, normsm.

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 is drug therapy, sometimes surgical intervention.

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 intoxication.

Heart failure is treated not only with pills. The patient must control the 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, and Digoxin are prescribed. Medicines that reduce the heart's need for oxygen will help alleviate the condition.

Restore blood flow in case of coronary disease and eliminate severe heart defects. surgical methods. An artificial heart driver can be installed for arrhythmia. 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. Sports activities.
3. Proper nutrition.
4. Rejection of bad habits.
5. Outdoor recreation.
6. Relief from stress.

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The materials are intended for informational and personal educational purposes. The site cannot be used to diagnose and treat diseases; be sure to visit your doctor! Support the site | about the project

To assess the performance of a continuously running human “engine,” many quantitative indicators are taken into account. Among them are cardiac output (CO) and cardiac ejection fraction (CEF).

The norm of these values ​​and comparison with them of the values ​​​​measured in a particular patient allow the doctor to obtain an objective idea of ​​the functional reserves of the “pumping” function of the myocardium and the existing pathologies in his cardiovascular system. vascular system.

The information, photos and videos in this article will help the average person understand the essence of these parameters, how they are measured, what affects the indicators of BC and FVS, and whether modern medicine influence the body to normalize these values.

Cardiac output is the total volume of blood flowing from the heart into the great vessels over a certain period of time or the volumetric velocity of blood flow. Typically, the time unit is equal to 1 minute, so among doctors the term “Minute Volume of Blood Circulation” or its abbreviation “MOC” is more often used.

Factors influencing the value of cardiac output

Cardiac output depends on:

• age and anthropometric indicators;
• human condition – rest (preload), after physical activity, psycho-emotional background;
• the frequency of myocardial contractions and its qualitative characteristics - stroke or systolic blood volume (SVV) flowing from the left ventricle into the aorta, and from the right ventricle into the pulmonary artery, during their contraction;
• the value of “venous return” - the blood volume flowing into the right atrium from the superior and inferior vena cava, into which blood from the whole body collects;
• dimensions of the thickness of the muscle wall and the volume of the heart chambers (see in the figure above).

For your information. The BC parameter is also influenced by specific indicators of the pumping (contractile) ability of the cardiac apparatus and the current state of the general resistance to blood flow of the system of peripheral blood vessels of the general circulation.

Reference values ​​and standard assessment parameters

Today it is quite easy to find out the exact indicators of cardiac hemodynamics. Most of them are calculated by a computer program during a non-invasive echocardiographic ultrasound examination.

The procedure can be done free of charge in a public clinic, or performed privately medical institution or laboratory, and even call a specialist with a portable device to your home. The price of the examination ranges from 700 to 6,500 rubles, and depends on the class of equipment.

There are other methods for determining VS and SWS - according to Fick, thermodilution, left ventriculography, Starr's formula. Their implementation is invasive, so they are used in cardiac surgery. A description of their essence will be understandable only to specialists, but for the average person we will clarify that they are intended to monitor the state of the cardiovascular system during operations, monitor the condition of a patient in intensive care, but some are sometimes performed to make an accurate diagnosis.

Whatever methods of measuring VS are used, its reference values ​​in a healthy adult who is in physical rest and psycho-emotional balance are fixed in the range from 4 to 6 l/min, while in one contraction from the left ventricle into the aorta 60 to 100 are pushed ml of blood. Such indicators are considered optimal provided that the heart beats at a speed of 60-90 beats/min, the upper pressure was in the range from 105 to 155, and the lower pressure was from 55 to 95 mm Hg. Art.

On a note. Unfortunately, echocardiography is not always enough to clarify a cardiac diagnosis. In addition to it, the doctor may prescribe CT tomography, PhonoCG, EPI, CT coronary angiography, and radionuclide diagnostics.

Cardiac output syndromes

A decrease in VS occurs due to a decrease in the speed and volume of “venous outflow”, as well as a violation of myocardial contractility.

The causes of low cardiac output syndrome include:

• Diseases or conditions caused by cardiac origin or complications after cardiac surgery:
  1. bradyarrhythmia, tachyarrhythmia;
  2. heart valve defects;
  3. end-stage congestive heart failure;
  4. metabolic disorders in the myocardium;
  5. occlusion of a shunt or main vessel;
  6. decreased blood volume;
  7. accumulation of air in the pleural cavity and compression of the lobes of the lungs;
  8. accumulation of fluid between the layers of the pericardium;
  9. oxygen starvation of the myocardium;
  10. a shift in the body’s acid-base balance towards increasing acidity (decreasing pH);
  11. sepsis;
  12. cardiogenic shock.
• Non-cardiac processes:
  1. massive blood loss;
  2. extensive burn;
  3. decreased nervous stimulation of the heart;
  4. sudden dilatation of veins;
  5. obstruction of large veins;
  6. anemia;
  7. carbon dioxide poisoning.

On a note. Aging of the body, prolonged physical inactivity, fasting, and diets that lead to a decrease in skeletal muscle volume cause persistent low cardiac output syndrome.

High BC is an adequate reaction of the heart in response to physical or psycho-emotional stress. The heart of a marathon athlete is capable of working at its maximum limit - with an increase in venous return and cardiac output by 2.5 times, pumping up to 40 liters per minute.

If the BC indicator is elevated at rest, then this may be a consequence of:

• the initial stage of hypertrophy of the heart walls - “athlete’s heart”;
• thyrotoxicosis;
• arteriovenous fistulas;
• chronic mitral and aortic insufficiency with left ventricular overload;
• low hemoglobin;
• beriberi diseases (vitaminosis B1);
• Paget's pathology (deforming osteodystrophy).

For your information. The increased load on the cardiovascular system during pregnancy causes an increase in CV, which returns to normal after childbirth.

What is cardiac ejection fraction

Among the criteria characterizing cardiac hemodynamics one can also find more “complex” parameters. Among them, Cardiac Ejection Fraction (CEF), which is the percentage ratio of the stroke systolic volume of blood pushed out of the left ventricle during heart compression to the volume of blood accumulated in it by the end of the period of relaxation of the heart muscle (diastole).

This indicator is used to make a prognosis for any cardiovascular pathology.

Reference values

The normal left ventricular ejection fraction at rest is 47-75%, and during psycho-emotional and physical stress its value can reach 85%. In old age, the rate decreases slightly. In children, the reference values ​​at rest are higher – 60-80%.

The value of FVS is determined during radionuclide angiography using the Simpson or Teicholz formulas. The survey form indicates which formula was applied, since discrepancies of up to 10% are possible.

Cardiologists pay attention to FVS in cases when it drops to 45% or below. Such values ​​are clinical symptom violations of contractile insufficiency and decreased performance of the heart muscle. Indicators below 35% indicate irreversible processes in the myocardium.

For your information. At the initial stage of any cardiac disease the ejection rate of the heart fraction does not change due to adaptive processes - thickening muscle tissue, restructuring of small-diameter vessels and alveoli, increasing the strength and/or number of contractions. A change in the value of the FVS occurs when the compensations are exhausted.

Reasons for the decline

Low cardiac ejection fraction occurs due to:

• diseases, infectious and inflammatory processes and myocardial defects;
• heavy load on the heart due to pulmonary hypertension;
• pathologies of coronary and pulmonary vessels;
• tumor formations and diseases of the thyroid, pancreas, and adrenal glands;
• diabetes mellitus, obesity;
• poisoning with alcohol, tobacco, drugs, .

Attention! Increasingly, cases of decreased myocardial contractility are being recorded in young and mature people who abuse energy drinks.

Symptoms

Although low fraction cardiac output in itself is a clinical symptom, it has its own characteristic features manifestations:

• increased breathing rate, possible attacks of suffocation;
• presyncope and fainting;
• “floaters” or “darkening” in the eyes;
• increase in heart rate to tachycardia levels;
• swelling of the lower extremities (feet, legs);
• numbness of hands and feet;
• gradual increase in liver size;
• pain syndrome (of varying nature and strength) in the area of ​​the heart and abdomen.

Important! Often, people suffering from diseases that are accompanied by a low ejection fraction of the heart look like they are drunk. Their coordination of movement is impaired, their gait becomes unsteady, their tongue becomes slurred, and other speech defects arise.

How to increase cardiac ejection fraction

Treatment of low cardiac ejection fraction is aimed at stabilizing pathological processes and occurs within the framework of standard therapy a disease or condition that causes a decrease in myocardial performance, and correction of left ventricular failure. In addition to hypertensive medications, the following may be prescribed: antiplatelet agents, blood thinners, anticoagulants, statins, peripheral vasodilators, antiarrhythmic drugs, aldosterone and angiotensin 2 receptor antagonists.

If the cardiac ejection fraction falls below 35%, treatment measures are aimed at improving the quality of life. If necessary, resynchronization therapy (artificial blockade) is performed. In cases of arrhythmias that threaten death, a pacemaker or cardiovector defibrillator is installed.

And at the end of the article, watch a video with detailed instructions on how to perform an exercise from Chinese health gymnastics that is accessible to everyone, which will help improve the cardiovascular system at the energy level.

Patients who have been referred for medical diagnostics of the heart and blood vessels come across such a concept as ejection fraction. It is measured by ultrasound, contrast x-ray and echocardiography.

In this article, the reader will become acquainted with the definition of “cardiac output”, norms and interpretation, and will also learn about methods of treatment and prevention.

If you have any questions, you can contact the portal specialists.

Competent consultations are provided free of charge 24 hours a day.

Concepts and symptoms

Ejection fraction is an indicator that determines the efficiency of the muscles of the heart organ at the moment of impact. It is measured as the percentage of blood volume entering the vessels during ventricular systole. For example, if there is 100 ml, 65 ml enters the vascular system, so the cardiac output will be 65%.

Basically, measurements are taken of the left ventricle, since from it blood enters the circulation in a large circle. If there is a lack of blood in this ventricle, this causes heart failure, which leads to the development of diseases of the organ.

Ejection fraction is not prescribed to all patients, but only to those who complain of:

• pain in the chest;
• systematic interruptions in the work of the organ;
• tachycardia;
• dyspnea;
• frequent dizziness and fainting;
• swelling of the lower extremities;
• fatigue and weakness;
• decreased productivity.

Typically, the first test is an electrocardiogram and ultrasound. These tests help determine the extent to which cardiac output occurs in both the left and right ventricles. Diagnostics are low cost, highly informative, and there is no specific training. The accessibility of the procedure is due to the fact that any ultrasound equipment can provide data on the fraction.

Normal fraction emission

The human heart, even without external stimuli, continues to work, pushing out over 50% of the blood at each systolic state. If this indicator begins to decrease to less than 50%, then deficiency is diagnosed. As a result of a decrease in volume, the myocardium develops, ischemia, defects, etc.

The ejection fraction varies in the range of 55-70 percent - this is the norm. A decrease to 35-40 percent entails dangerous interruptions. To prevent a fatal fall, it is necessary to visit a cardiologist at least once a year. For persons over 40 years of age, this is a mandatory procedure. The symptomatic picture described above is a good reason to contact a qualified cardiologist.

Cardiac output When diagnosing a patient’s body with pathologies in the cardiovascular system, an important priority is to determine the individual minimum threshold. Based on the information, the doctor can make a diagnosis and prescribe the correct therapy.

Ultrasound - norms and interpretation

At the end of the ultrasound examination, the diagnostician draws up a protocol where he enters all the data obtained on the condition of the left ventricle. Subsequently, the information is decrypted. When pathologies are identified, the doctor explains the results obtained and a diagnosis is established.

Even without a medical education, a person can independently decipher the main indicators and see the clinical picture of the examined organ. Decoding occurs by comparing the information received with a standard table.

• ejection fraction, interval: 55 -60%;
• size of the atrium of the right chamber: 2.7-4.5 cm;
• stroke volume: 60-100 ml;
• aortic diameter: 2.1-4.1 cm;
• diastolic wall thickness: 0.75-1.1 cm;
• systole size: 3.1-4.3 cm;
• size of the atrium of the left chamber: 1.9 to 4 cm.

The above indicators must be considered in their entirety. Deviation from the norm of one is not a suspicion of a pathological process, but may require additional diagnostics.

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How to treat low fraction level?

Having information about the cardiac output rate, the reader can analyze the performance of the organ. When left ventricular output is below normal, it is recommended to consult a cardiologist as soon as possible. It is worth noting that the doctor is primarily interested not in the presence of pathology, but in the cause of the development of the disease. Therefore, after ultrasound, additional studies are often carried out.

Low ventricular output is most often characterized by feeling unwell, swelling and shortness of breath. How to increase the volume of the fraction? We live in an era of progressive medicine, so in the arsenal of doctors to increase the release of blood into the vessels, therapy takes first place. Basically, the patient is undergoing outpatient treatment, during which specialists monitor the activity of the heart and vascular system. Besides drug treatment, sometimes surgery is performed.

• Fluid intake is strictly regulated and amounts to 1.5-2 liters of water per day;
• refusal of salt, seasonings and dishes containing it;
• dietary ration;
• moderate physical activity;
• reception medicines: urinary tract stimulants, inhibitors, adrenaline blockers, digoxin, etc.

Blood supply can be restored surgically. As a rule, operations are prescribed for patients who have been diagnosed with severe heart or valve defects. Often, the valves are resected and prostheses are installed. This approach allows you to normalize the heart rhythm and eliminate arrhythmia and fibrillation. It should be noted that operations are carried out if there is a high danger to human life. In all other cases, therapy is carried out.

Preventive methods

In the absence of a genetic predisposition to diseases of the cardiovascular system, it is possible to maintain a normal fraction without difficulty.

• daily exercise;
• eating foods rich in iron;
• do not abuse alcohol-containing drinks and tobacco;
• maintain a healthy regimen;
• Do aerobics 2-3 times a week;
• choose foods with low salt levels.

The main key is aerobics. There is an opinion that for diseases of the heart and blood vessels, physical activity is harmful. It is a myth.

Only heavy lifting can cause harm, i.e. Gym prohibited for patients. Aerobic exercise, on the contrary, strengthens the walls of blood vessels and does not overload the heart. Such exercises improve muscle function by removing oxygen from the blood. It is necessary to exercise gradually increasing the load.

According to 20th century statistics, heart vascular diseases Elderly people were most often affected. Today this has also affected the younger generation. The main risk group includes residents of megacities who suffer from low levels of clean air and exhaust gases. Therefore, it is very important for every person to undergo annual medical examination not only from the cardiologist, but also from other doctors. Remember that only you are responsible for your health!

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If you have already passed ultrasonography kidneys or, for example, abdominal organs, then you remember that in order to roughly decipher their results, most often you do not have to contact a doctor - basic information can be found out before visiting a doctor, by reading the report yourself. The results of a heart ultrasound are not so easy to understand, so it can be difficult to decipher them, especially if you analyze each indicator by number.

You can, of course, just look at the last lines of the form, where a general summary of the research is written, but this also does not always clarify the situation. So that you can better understand the results obtained, we present the basic norms of cardiac ultrasound and possible pathological changes that can be determined by this method.

Ultrasound standards for heart chambers

To begin with, we will present a few numbers that are sure to appear in every Doppler echocardiography report. They reflect various parameters of the structure and functions of individual chambers of the heart. If you are a pedant and take a responsible approach to deciphering your data, pay maximum attention to this section. Perhaps, here you will find the most detailed information in comparison with other Internet sources intended for a wide range of readers. Data may vary slightly between sources; Here are the figures based on materials from the manual “Norms in Medicine” (Moscow, 2001).

Left ventricular parameters

Left ventricular myocardial mass: men – 135-182 g, women – 95-141 g.

Left ventricular myocardial mass index (often referred to as LVMI on the form): men 71-94 g/m2, women 71-89 g/m2.

End-diastolic volume (EDV) of the left ventricle (the volume of the ventricle that it has at rest): men – 112±27 (65-193) ml, women 89±20 (59-136) ml

End-diastolic dimension (EDV) of the left ventricle(size of the ventricle in centimeters, which it has at rest): 4.6 – 5.7 cm

End systolic dimension (ESD) of the left ventricle(size of the ventricle it has during contraction): 3.1 – 4.3 cm

Wall thickness in diastole(outside heartbeat): 1.1 cm

With hypertrophy - an increase in the thickness of the ventricular wall due to too much load on the heart - this figure increases. Figures of 1.2–1.4 cm indicate slight hypertrophy, 1.4–1.6 indicate moderate hypertrophy, 1.6–2.0 indicate significant hypertrophy, and a value of more than 2 cm indicates high degree hypertrophy.

Ejection fraction (EF): 55-60%.

At rest, the ventricles are filled with blood, which is not completely ejected from them during contractions (systole). The ejection fraction shows how much blood relative to the total amount the heart ejects with each contraction; normally it is slightly more than half. When the EF indicator decreases, they speak of heart failure, which means that the organ pumps blood ineffectively, and it can stagnate.

Stroke volume(the amount of blood that is ejected by the left ventricle in one contraction): 60-100 ml.

Right ventricular parameters

Wall thickness: 5 ml

Size index 0.75-1.25 cm/m2

Diastolic size (size at rest) 0.95-2.05 cm

Parameters of the interventricular septum

Resting thickness (diastolic thickness): 0.75-1.1 cm

Excursion (moving from side to side during heart contractions): 0.5-0.95 cm. An increase in this indicator is observed, for example, with certain heart defects.

Right atrium parameters

For this chamber of the heart, only the value of EDV is determined - the volume at rest. A value of less than 20 ml indicates a decrease in EDV, a value of more than 100 ml indicates its increase, and an EDV of more than 300 ml occurs with a very significant increase in the right atrium.

Left atrium parameters

Size: 1.85-3.3 cm

Size index: 1.45 – 2.9 cm/m2.

Most likely, even a very detailed study of the parameters of the heart chambers will not give you particularly clear answers to the question about the state of your health. You can simply compare your indicators with the optimal ones and on this basis draw preliminary conclusions about whether everything is generally normal for you. For more detailed information, contact a specialist; The volume of this article is too small for wider coverage.

Ultrasound standards for heart valves

As for deciphering the results of a valve examination, it should present a simpler task. It will be enough for you to look at the general conclusion about their condition. There are only two main, most common pathological processes: stenosis and valve insufficiency.

The term "stenosis" indicates a narrowing of the valve opening, in which the overlying chamber of the heart has difficulty pumping blood through it and may undergo hypertrophy, which we discussed in the previous section.

Failure– this is the opposite state. If the valve leaflets, which normally prevent the reverse flow of blood, for some reason cease to perform their functions, the blood that has passed from one chamber of the heart to another partially returns, reducing the efficiency of the organ.

Depending on the severity of the disorders, stenosis and insufficiency can be grade 1, 2 or 3. The higher the degree, the more serious the pathology.

Sometimes in the conclusion of a cardiac ultrasound you can find such a definition as “relative insufficiency”. In this condition, the valve itself remains normal, and blood flow disturbances occur due to the fact that pathological changes occur in the adjacent chambers of the heart.

Ultrasound standards for the pericardium

The pericardium, or pericardial sac, is the “bag” that surrounds the outside of the heart. It fuses with the organ in the area where the vessels originate, in its upper part, and between it and the heart itself there is a slit-like cavity.

The most common pathology of the pericardium is inflammatory process, or pericarditis. With pericarditis, adhesions can form between the pericardial sac and the heart and fluid can accumulate. Normally, it is 10-30 ml, 100 ml indicates a small accumulation, and over 500 indicates a significant accumulation of fluid, which can lead to difficulty in the full functioning of the heart and its compression...

To master the specialty of a cardiologist, a person must first study at the university for 6 years, and then study cardiology separately for at least a year. A qualified doctor has all the necessary knowledge, thanks to which he can not only easily decipher the conclusion to an ultrasound of the heart, but also make a diagnosis based on it and prescribe treatment. For this reason, deciphering the results of such a complex study as ECHO-cardiography should be provided to a specialized specialist, rather than trying to do it yourself, poking around for a long time and unsuccessfully with the numbers and trying to understand what certain indicators mean. This will save you a lot of time and nerves, since you will not have to worry about your probably disappointing and, even more likely, incorrect conclusions about your health.

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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 in case of left ventricular failure, the clinical picture of heart failure most often develops.

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 they do not receive the required amount of oxygen and nutrients from the 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 with deadly consequences.

Reasons for decreased EF

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

1. Cardiac ischemia. At the same time, blood flow through the 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, prolonged hypertension, and 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 caused by long walk, as well as performing simple housework: washing floors, cooking.

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 on the 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. Drugs are prescribed to improve myocardial contractility. 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 is of great importance, especially in children. In the century 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.

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The amount of blood ejected by the ventricle of the heart into the arteries per minute is an important indicator of the functional state of the cardiovascular system (CVS) and is called minute volume blood (IOC). It is the same for both ventricles and at rest is 4.5–5 liters.

An important characteristic of the pumping function of the heart is given by stroke volume , also called systolic volume or systolic ejection . Stroke volume- the amount of blood ejected by the ventricle of the heart into the arterial system in one systole. (If we divide the IOC by heart rate per minute we get systolic volume (CO) of blood flow.) With a heart contraction of 75 beats per minute, it is 65–70 ml; during work it increases to 125 ml. In athletes at rest it is 100 ml, during work it increases to 180 ml. The determination of MOC and CO is widely used in the clinic.

Ejection fraction (EF) – expressed as a percentage, the ratio of the stroke volume of the heart to the end-diastolic volume of the ventricle. EF at rest in a healthy person is 50-75%, and during physical activity it can reach 80%.

The volume of blood in the ventricular cavity that it occupies before its systole is end-diastolic volume (120–130 ml).

End-systolic volume (ECO) is the amount of blood remaining in the ventricle immediately after systole. At rest, it is less than 50% of the EDV, or 50-60 ml. Part of this blood volume is reserve volume.

The reserve volume is realized when CO increases under load. Normally, it is 15–20% of the end-diastolic value.

The volume of blood in the cavities of the heart remaining when the reserve volume is fully realized at maximum systole is residual volume. CO and IOC values ​​are not constant. During muscular activity, IOC increases to 30–38 l due to increased heart rate and increased CO2.

A number of indicators are used to assess the contractility of the heart muscle. These include: ejection fraction, rate of blood expulsion during the rapid filling phase, rate of increase in pressure in the ventricle during the period of stress (measured by probing the ventricle)/

Blood expulsion rate changes using Doppler ultrasound of the heart.

Pressure rise rate in the cavities of the ventricles is considered one of the most reliable indicators of myocardial contractility. For the left ventricle, the normal value of this indicator is 2000-2500 mmHg/s.

A decrease in the ejection fraction below 50%, a decrease in the rate of blood expulsion, and the rate of pressure increase indicate a decrease in myocardial contractility and the possibility of developing insufficiency of the pumping function of the heart.

The IOC value divided by the body surface area in m2 is determined as cardiac index(l/min/m2).

SI = MOK/S (l/min×m 2)

It is an indicator of the pumping function of the heart. Normally, the cardiac index is 3–4 l/min×m2.

IOC, UOC and SI are united by a common concept cardiac output.

If the IOC and blood pressure in the aorta (or pulmonary artery) are known, the external work of the heart can be determined

P = IOC × BP

P - heart work per minute in kilograms (kg/m).

MOC - minute blood volume (l).

Blood pressure is pressure in meters of water column.

At physical rest, the external work of the heart is 70–110 J; during work it increases to 800 J, for each ventricle separately.

Thus, the work of the heart is determined by 2 factors:

1. The amount of blood flowing to it.

2. Vascular resistance during the expulsion of blood into the arteries (aorta and pulmonary artery). When the heart cannot pump all the blood into the arteries at a given vascular resistance, heart failure occurs.

There are 3 types of heart failure:

1. Insufficiency from overload, when excessive demands are placed on the heart with normal contractility due to defects, hypertension.

2. Heart failure due to myocardial damage: infections, intoxications, vitamin deficiencies, impaired coronary circulation. At the same time, the contractile function of the heart decreases.

3. Mixed form of failure - with rheumatism, dystrophic changes in the myocardium, etc.

The entire complex of manifestations of cardiac activity is recorded using various physiological techniques - cardiographs: ECG, electrokymography, ballistocardiography, dynamocardiography, apical cardiography, ultrasound cardiography, etc.

The diagnostic method for the clinic is the electrical recording of the movement of the contour of the heart shadow on the screen of the X-ray machine. A photocell connected to an oscilloscope is applied to the screen at the edges of the heart contour. As the heart moves, the illumination of the photocell changes. This is recorded by an oscilloscope in the form of a curve of contraction and relaxation of the heart. This technique is called electrokymography.

Apical cardiogram recorded by any system that detects small local movements. The sensor is fixed in the 5th intercostal space above the site of the cardiac impulse. Characterizes all phases cardiac cycle. But it is not always possible to register all phases: the cardiac impulse is projected differently, and part of the force is applied to the ribs. The recording may differ from person to person and from one person to another, depending on the degree of development of the fat layer, etc.

The clinic also uses research methods based on the use of ultrasound - Ultrasound cardiography.

Ultrasonic vibrations at a frequency of 500 kHz and higher penetrate deeply through tissues being generated by ultrasound emitters applied to the surface of the chest. Ultrasound is reflected from tissues of various densities - from the outer and inner surface of the heart, from blood vessels, from valves. The time it takes for the reflected ultrasound to reach the capturing device is determined.

If the reflective surface moves, the return time of the ultrasonic vibrations changes. This method can be used to record changes in the configuration of heart structures during its activity in the form of curves recorded from the screen of a cathode ray tube. These techniques are called non-invasive.

Invasive techniques include:

Catheterization of the heart cavities. An elastic catheter probe is inserted into the central end of the opened brachial vein and pushed towards the heart (into its right half). A probe is inserted into the aorta or left ventricle through the brachial artery.

Ultrasound scanning- the ultrasound source is inserted into the heart using a catheter.

Angiography is a study of heart movements in a field of X-rays, etc.

Mechanical and sound manifestations of cardiac activity. Heart sounds, their genesis. Polycardiography. Comparison in time of periods and phases of the cardiac cycle of ECG and FCG and mechanical manifestations of cardiac activity.

Heart beat. During diastole, the heart takes the shape of an ellipsoid. During systole, it takes on the shape of a ball, its longitudinal diameter decreases, and its transverse diameter increases. During systole, the apex rises and presses against the anterior chest wall. A cardiac impulse occurs in the 5th intercostal space, which can be recorded ( apical cardiography). The expulsion of blood from the ventricles and its movement through the vessels, due to reactive recoil, causes vibrations of the entire body. Registration of these oscillations is called ballistocardiography. The work of the heart is also accompanied by sound phenomena.

Heart sounds. When listening to the heart, two tones are detected: the first is systolic, the second is diastolic.

Systolic the tone is low, drawn-out (0.12 s). Several overlapping components are involved in its genesis:

1. Closing component mitral valve.

2. Closure of the tricuspid valve.

3. Pulmonary tone of blood expulsion.

4. Aortic blood expulsion tone.

The characteristic of the first tone is determined by the tension of the leaflet valves, the tension of the tendon threads, papillary muscles, and the walls of the ventricular myocardium.

Components of blood expulsion occur when the walls of the great vessels are tense. The first sound is clearly audible in the 5th left intercostal space. In pathology, the genesis of the first tone involves:

1. Opening component aortic valve.

2. Opening of the pulmonary valve.

3. Tone of pulmonary artery distension.

4. Aortic stretch tone.

Strengthening of the first tone can occur with:

1. Hyperdynamics: physical activity, emotions.

When there is a violation of the time relationship between the systole of the atria and ventricles.

With poor filling of the left ventricle (especially with mitral stenosis, when the valves do not open completely). The third option of amplifying the first tone has significant diagnostic value.

Weakening of the first sound is possible with mitral valve insufficiency, when the valves do not close tightly, with myocardial damage, etc.

II tone - diastolic(high, short 0.08 s). Occurs when the closed semilunar valves are tense. On a sphygmogram its equivalent is incisura. The higher the pressure in the aorta and pulmonary artery, the higher the tone. It can be heard well in the 2nd intercostal space on the right and left of the sternum. It intensifies with sclerosis of the ascending aorta and pulmonary artery. The sound of the 1st and 2nd heart sounds most closely conveys the combination of sounds when pronouncing the phrase “LAB-DAB”.

Cardiac output is one of the most important characteristics that allows you to control the state of the cardiovascular system. This concept refers to the volume of blood pumped by the heart into the vessels over a certain interval, measured by the time interval or contractile movements of the heart muscle.

The volume of blood pushed out by the heart into the vascular system is defined as minute volume (MOC) and systolic, also known as stroke volume (SV).

To determine the IOC, the amount of blood passing through one of the atria in 1 minute is calculated. The characteristic is measured in liters or milliliters. Taking into account the individuality of the human body, as well as the difference in physical data, experts introduced the concept of cardiac index (CI). This value is calculated by the ratio of the IOC to the total surface area of ​​the body, which is measured in square meters. The SI unit is l/min. m².

When transporting oxygen through a closed system, blood circulation plays the role of a kind of limiter. The greatest indicator of minute volume of blood circulation obtained during maximum muscle tension, when compared with the indicator recorded under normal conditions, allows one to determine the functional reserve of the cardiovascular system and specifically the heart by hemodynamics.

If a person is healthy, the hemodynamic reserve varies from 300 to 400%. The figures inform that without any danger to the body’s condition, a three- to four-fold increase in IOC, which is observed at rest, is possible. In people who regularly engage in sports and are physically well developed, this figure can exceed 700%.

When the body is in horizontal position and at the same time any physical activity is excluded, the IOC is in the range from 4 to 5.5 (6) l/min. Normal SI under the same conditions does not leave the range of 2–4 l/min. m².

Relationship between the IOC and organs at rest

The amount of blood filling the circulatory system of a normal person is 5–6 liters. One minute is enough to complete a full circuit. With heavy physical work and increased sports loads, the IOC of an ordinary person increases to 30 l/min, and for professional athletes even more - up to 40.

In addition to physical condition, IOC indicators largely depend on:

• systolic blood volume;
• heart rate;
• functionality and status venous system, through which blood returns to the heart.

Systolic blood volume

Systolic blood volume refers to the amount of blood pushed by the ventricles into the great vessels during one heartbeat. Based on this indicator, a conclusion is made about the strength and efficiency of the heart muscle. In addition to systolic, this characteristic is often called stroke volume or VT.

Systolic volume of blood circulation is calculated by the amount of blood pushed by the heart into the vessels during one contraction

At rest and in the absence of physical activity, during one contraction of the heart, 0.3–0.5 volumes of blood are pushed out to diastole, filling its chamber. The remaining blood is a reserve, which can be used in case of a sharp increase in physical, emotional or other activity.

The blood remaining in the chamber becomes the main determinant that determines the functional reserve of the heart. The larger the reserve volume, the more blood can be supplied to the circulatory system as needed.

When the circulatory system begins to adapt to certain conditions, the systolic volume undergoes a change. Extracardiac nervous mechanisms take an active part in the process of self-regulation. In this case, the main effect is on the myocardium, or more precisely, on the force of its contraction. A decrease in the power of myocardial contractions leads to a decrease in systolic volume.

For the average person, whose body is in a horizontal position and does not experience physical stress, it is normal if the OC varies between 70–100 ml.

Factors influencing IOC

Cardiac output is a variable value, and there are quite a few factors that change it. One of them is pulse, expressed as heart rate. At rest and in a horizontal position of the body, its average is 60–80 beats per minute. Changes in pulse occur under the influence of chronotropic influences, and inotropic influences affect strength.

An increase in heart rate leads to an increase in minute blood volume. These changes play an important role in the process of accelerating the adaptation of the IOC to the relevant situation. When the body is exposed to extreme stress, there is an increase in heart rate of 3 or more times compared to normal. Heart rhythm changes under the chronotropic influence exerted by the sympathetic and vagus nerves on the sinoatrial node of the heart. In parallel with chronotropic changes in cardiac activity, inotropic effects may be exerted on the myocardium.

Systemic hemodynamics is also determined by the work of the heart. To calculate this indicator, it is necessary to multiply the data on the average pressure and the mass of blood that is pumped into the aorta over a certain time interval. The result informs how the left ventricle is functioning. To establish the work of the right ventricle, it is enough to reduce the resulting value by 4 times.

If cardiac output indicators do not correspond to the norm and there are no external influences observed, then this fact indicates abnormal functioning of the heart, therefore, the presence of pathology.

Decreased cardiac output

The most common causes of low cardiac output are violations of basic cardiac functions. These include:

• damaged myocardium;
• blocked coronary vessels;
• abnormally functioning heart valves;
• disrupted metabolic processes occurring in the heart muscle.

When cardiac output decreases and tissues are no longer supplied with nutrients, cardiogenic shock can occur.

The main reason leading to a decrease in cardiac output lies in the insufficient supply of venous blood to the heart. This factor has a negative impact on the IOC. The process is determined by:

• a decrease in the amount of blood involved in circulation;
• decrease in tissue mass;
• blockage of large veins and expansion of ordinary ones.

A decrease in the amount of circulating blood helps to reduce the IOC to a critical threshold. A shortage of blood begins to be felt in the vascular system, which affects the amount of blood returned to the heart.

When fainting occurs due to disorders in the nervous system, small arteries become dilated and veins become enlarged. The result is a decrease in blood pressure and, as a consequence, insufficient blood volume entering the heart.

If the vessels supplying blood to the heart undergo changes, they may partially block. This immediately affects peripheral vessels that are not involved in the supply of blood to the heart. The resulting reduced amount of blood sent to the heart causes low cardiac output syndrome. Its main symptoms are expressed:

• drop in blood pressure;
• low heart rate;
• tachycardia.

This process is accompanied external factors: cold sweat, small volume of urination and changes in skin color (pallor, blueness).

The final diagnosis is made by an experienced cardiologist after carefully studying the test results.

Increased cardiac output

The level of cardiac output depends not only on physical activity, but also on the psycho-emotional state of a person. Job nervous system can reduce and increase the IOC index.

Sports activities are accompanied by an increase in blood pressure. Accelerating metabolism contracts skeletal muscles and dilates arterioles. This factor allows oxygen to be supplied to the muscles to the required extent. Loads lead to a narrowing of large veins, an increase in heart rate and an increase in the strength of contractions of the heart muscle. High blood pressure causes a powerful blood flow to the skeletal muscles.

Increased cardiac output is most often observed in following cases:

• arteriovenous fistula;
• thyrotoxicosis;
• anemia;
• vitamin B deficiency.

In an arteriovenous fistula, the artery is directly connected to the vein. This phenomenon is called a fistula and comes in two types. Congenital arteriovenous fistula is accompanied by benign formations on the skin and can be located on any organ. In this variant, it is expressed by embryonic fistulas that have not reached the stages of veins or arteries.

An acquired arteriovenous fistula is formed under the influence of external influence. It is created if there is a need for hemodialysis. Often a fistula becomes the result of catheterization, as well as a consequence of surgical intervention. Such a fistula sometimes accompanies penetrating wounds.

A large fistula provokes increased cardiac output. When she takes chronic form, heart failure is possible, in which the IOC reaches critically high levels.

Thyrotoxicosis is characterized by a rapid pulse and increased arterial pressure. In parallel with this, not only quantitative changes in the blood occur, but also qualitative ones. An increase in the level of thyraxine is promoted by an abnormal level of erythropatine and, as a consequence, a decreased erythrocyte mass. The result is increased cardiac output.

With anemia, blood viscosity decreases and the heart is able to pump more of it. This leads to increased blood flow and increased heart rate. Tissues receive more oxygen, and accordingly, cardiac output and IOC increase.

Lack of vitamin B 1 is the cause of many pathologies

Vitamin B 1 is involved in blood formation and has a beneficial effect on blood microcirculation. Its action significantly affects the functioning of the heart muscles. A lack of this vitamin contributes to the development of beriberi disease, one of the symptoms of which is impaired blood flow. With active metabolism, tissues stop absorbing the nutrients they need. The body compensates for this process by dilating peripheral vessels. Under such conditions, cardiac output and venous return can exceed the norm by two or more times.

Cardiac output fraction and diagnosis

The concept of ejection fraction was introduced into medicine to determine the performance of the heart muscles at the time of contraction. It allows you to determine how much blood was pushed from the heart into the vessels. The unit of measurement is set to percentage.

The left ventricle is selected as the object of observation. Its direct connection with the systemic circulation makes it possible to accurately determine heart failure and identify pathology.

Ejection fraction is prescribed in the following cases:

• with constant complaints about heart function;
• chest pain;
• shortness of breath;
• frequent dizziness and fainting;
• low performance, fatigue;
• swelling of the legs.

The initial analysis is carried out using ECG and ultrasound equipment.

Fraction norm

During each systolic state, the heart of a person who is not experiencing increased physical and psycho-emotional stress throws up to 50% of the blood into the vessels. If this indicator begins to noticeably decrease, insufficiency is observed, which indicates the development of ischemia, heart disease, myocardial pathologies, etc.

A – normal fraction, B – 45% fraction

The ejection fraction norm is 55–70%. Its drop to 45% and below becomes critical. To prevent the negative consequences of such a decline, especially after 40 years, an annual visit to a cardiologist is necessary.

If the patient already has pathologies of the cardiovascular system, then in this case there is a need to determine an individual minimum threshold.

After conducting the study and comparing the data obtained with the norm, the doctor makes a diagnosis and prescribes appropriate therapy.

Ultrasound does not reveal the full picture of the pathology and, since the doctor is more interested in identifying the cause of this disease, most often it is necessary to resort to additional studies.

Treatment of low fraction level

Low cardiac output is usually accompanied by general malaise. To normalize health, the patient is prescribed outpatient treatment. During this period, constant monitoring of the functioning of the cardiovascular system is carried out, and the therapy itself involves taking medications.

In particularly critical cases, surgery may be performed. This procedure is preceded by the identification of a severe defect or serious disorders of the valve apparatus in the patient.

Surgery becomes inevitable when low level cardiac output becomes life-threatening for the patient. In general, conventional therapy is sufficient.

Self-treatment and prevention of low ejection fraction

To normalize the ejection fraction, you must:

• Introduce control over the liquids taken, reduce their volume to 1.5–2 liters per day.
• Avoid salty and spicy foods.
• Go to dietary products.
• Reduce physical activity.

As preventive measures, allowing to avoid deviations from the norm of cardiac ejection fraction, are:

• rejection of bad habits;
• maintaining a daily routine;
• eating iron-containing foods;
• exercises and light gymnastics.

If there is the slightest malfunction of the heart or even suspicion of these manifestations, you must immediately see a cardiologist. Timely detection of pathology greatly simplifies and speeds up its elimination.

Symptoms of indicators going beyond normal limits, principles of treatment and prognosis.

Ejection fraction (EF) is the ratio of stroke volume (blood that enters the aorta during one contraction of the heart muscle) to the end-diastolic volume of the ventricle (blood that accumulates in the cavity during the period of relaxation, or diastole, of the myocardium). The resulting value is multiplied by 100% to obtain the final value. That is, this is the percentage of blood that the ventricle pushes out during systole from the total volume of fluid it contains.

The indicator is calculated by a computer during an ultrasonographic examination of the heart chambers (echocardiography or ultrasound). It is used only for the left ventricle and directly reflects its ability to perform its function, that is, to ensure adequate blood flow throughout the body.

Under conditions of physiological rest, the normal value of EF is considered to be 50–75%; during physical activity in healthy people it increases to 80–85%. There is no further increase, since the myocardium cannot eject all the blood from the ventricular cavity, which will lead to cardiac arrest.

In medical terms, only a decrease in the indicator is assessed - this is one of the main criteria for the development of a decrease in cardiac performance, a sign of myocardial contractile failure. This is indicated by an EF value below 45%.

Such insufficiency poses a great danger to life - a small supply of blood to the organs disrupts their functioning, which ends in multiple organ dysfunction and ultimately leads to the death of the patient.

Considering that the reason for the decrease in left ventricular ejection volume is its systolic failure (as is the outcome of many chronic pathologies of the heart and blood vessels), it is impossible to completely cure this condition. Treatment is carried out to support the myocardium and aimed at stabilizing the condition at one level.

Cardiologists and therapists are involved in monitoring and selecting therapy for patients with low ejection fraction. Under certain conditions, the assistance of a vascular or endovascular surgeon may be required.

Features of the indicator

1. The ejection fraction does not depend on the gender of the person.
2. With age, a physiological decline in this indicator is noted.
3. A low EF may be an individual norm, but a value of less than 45% is always considered pathological.
4. All healthy people have an increase in value with an increase in heart rate and blood pressure levels.
5. The normal indicator when measuring by radionucleide angiography is considered to be 45–65%.
6. The Simpson or Teicholz formulas are used for measurement; normal values, depending on the method used, range up to 10%.
7. A critical level of reduction of 35% or less is a sign of irreversible changes in myocardial tissue.
8. For children in the first years of life, higher rates of 60–80% are typical.
9. The indicator is used to determine the prognosis of any cardiovascular disease in patients.

Reasons for the decline

At the initial stages of any disease, the ejection fraction remains normal due to the development of adaptation processes in the myocardium (thickening of the muscle layer, increased work, restructuring of small blood vessels). As the disease progresses, the heart's capacity becomes exhausted, the contractility of muscle fibers becomes impaired, and the volume of blood ejected decreases.

Such disorders are caused by all influences and diseases that have a negative effect on the myocardium.

Acute myocardial infarction

Scar changes in cardiac tissue (cardiosclerosis)

Painless form of ischemia

Tachy and bradyarrhythmias

Ventricular wall aneurysm

Endocarditis (changes in the inner lining)

Pericarditis (heart sac disease)

Congenital disorders of the normal structure or defects (violation of the correct location, significant reduction in the lumen of the aorta, pathological connection between large vessels)

Aneurysm of any part of the aorta

Aortoarteritis (damage to the walls of the aorta and its branches by cells of their own immunity)

Thromboembolism of pulmonary vessels

Diabetes mellitus and impaired glucose absorption

Hormone-active tumors of the adrenal glands, pancreas (pheochromocytoma, carcinoid)

Stimulant drugs

Symptoms of a decrease in indicator

Low ejection fraction is one of the main criteria for cardiac dysfunction, so patients are forced to significantly limit their work and physical activity. Often, even simple housework causes a deterioration in the condition, which forces you to spend most of your time sitting or lying in bed.

Manifestations of a decrease in the indicator are distributed by frequency of occurrence from the most frequent to the rarer:

• significant loss of strength and fatigue from usual activities;
• breathing disorders such as an increase in frequency, up to attacks of suffocation;
• breathing problems worsen when lying down;
• collapsed states and loss of consciousness;
• changes in vision (darkening in the eyes, “spots”);
• pain in the projection of the heart of varying intensity;
• increased number of heart contractions;
• swelling of the legs and feet;
• accumulation of fluid in the chest and abdomen;
• gradual increase in liver size;
• progressive weight loss;
• episodes of impaired coordination and gait;
• periodic decrease in sensitivity and active mobility in the limbs;
• discomfort, moderate pain in the projection of the abdomen;
• unstable stool;
• attacks of nausea;
• vomiting with blood;
• blood in stool.

Treatment if the indicator decreases

An ejection fraction of less than 45% is a consequence of changes in the functionality of the heart muscle against the background of progression of the underlying disease-cause. A decrease in the indicator is a sign of irreversible changes in the myocardial tissue, and there is no talk of the possibility of a complete cure. All therapeutic measures are aimed at stabilizing pathological changes at their early stages and improving the patient’s quality of life at a later stage.

The treatment complex includes:

• carrying out correction of the underlying pathological process;
• treatment of left ventricular failure.

This article is devoted directly to left ventricular ejection fraction and the types of its disorders, so further we will talk only about this part of the treatment.

Cardiac ejection fraction

When Inge Elder proposed using ultrasound to visualize human organs in the 1950s, he was not mistaken. Today, this method plays an important and sometimes key role in the diagnosis of heart diseases. Let's talk about decoding its indicators.

1 Important diagnostic method

Ultrasound examination of the heart

Echocardiographic examination of the cardiovascular system is a very important and also quite accessible diagnostic method. In some cases, the method is the “gold standard”, allowing one or another diagnosis to be verified. In addition, the method makes it possible to identify hidden heart failure that does not manifest itself during intense physical activity. Echocardiographic findings (normal values) may vary somewhat depending on the source. We present the guidelines proposed by the American Association of Echocardiography and the European Association of Cardiovascular Imaging in 2015.

2 Ejection fraction

Healthy ejection fraction and pathological (less than 45%)

Ejection fraction (EF) has an important diagnostic value, as it allows one to evaluate systolic function LV and right ventricles. Ejection fraction is the percentage of blood volume that is expelled into the vessels from the right and left ventricles during systole. If, for example, from 100 ml of blood 65 ml of blood entered the vessels, as a percentage this will be 65%.

Left ventricle. The normal left ventricular ejection fraction for men is ≥ 52%, for women - ≥ 54%. In addition to the LV ejection fraction, the LV shortening fraction is also determined, which reflects the state of its pumping (contractile) function. The norm for the shortening fraction (SF) of the left ventricle is ≥ 25%.

Low left ventricular ejection fraction may occur with rheumatic heart disease, dilated cardiomyopathy, myocarditis, myocardial infarction, and other conditions that lead to heart failure (weakness of the heart muscle). A decrease in left ventricular EF is a sign of LV heart failure. Left ventricular FU decreases in heart diseases that lead to heart failure - myocardial infarction, heart defects, myocarditis, etc.

Right ventricle. The normal ejection fraction for the right ventricle (RV) is ≥ 45%.

3 Dimensions of heart chambers

The dimensions of the heart chambers are a parameter that is determined in order to exclude or confirm overload of the atria or ventricles.

Left atrium. The normal left atrium (LA) diameter in mm for men is ≤ 40, for women ≤ 38. An increase in the diameter of the left atrium may indicate heart failure in the patient. In addition to the LA diameter, its volume is also measured. The normal LA volume in mm3 for men is ≤ 58, for women ≤ 52. LA size increases with cardiomyopathies, mitral valve defects, arrhythmias (heart rhythm disturbances), congenital defects hearts.

Right atrium. For the right atrium (RA), as well as for the left atrium, the dimensions (diameter and volume) are determined by echocardiography. Normally, the diameter of the PP is ≤ 44 mm. Right atrium volume is divided by body surface area (BSA). For men, the normal ratio of PP/PPT volume is ≤ 39 ml/m2, for women - ≤33 ml/m2. The size of the right atrium may increase with failure of the right heart. Pulmonary hypertension, pulmonary embolism, chronic obstructive pulmonary disease and other diseases can cause the development of right atrial insufficiency.

ECHO Cardiography (ultrasound of the heart)

Left ventricle. The ventricles have their own parameters regarding their sizes. Since the practicing physician is interested in the functional state of the ventricles in systole and diastole, there are corresponding indicators. Main size indicators for the left ventricle:

1. Diastolic size in mm (men) - ≤ 58, women - ≤ 52;
2. Diastolic size/PPT (men) - ≤ 30 mm/m2, women - ≤ 31 mm/m2;
3. End-diastolic volume (men) - ≤ 150 ml, women - ≤ 106 ml;
4. End-diastolic volume/BSA (men) - ≤ 74 ml/m2, women - ≤61 ml/m2;
5. Systolic size in mm (men) - ≤ 40, women - ≤ 35;
6. End systolic volume (men) - ≤ 61 ml, women - ≤ 42 ml;
7. End-systolic volume/BSA (men) - ≤ 31 ml/m2, women - ≤ 24 ml/m2;

Indicators of diastolic and systolic volume and size may increase with myocardial diseases, heart failure, as well as with congenital and acquired heart defects.

Myocardial mass indicators

The mass of the LV myocardium may increase as its walls thicken (hypertrophy). The cause of hypertrophy may be various diseases of cardio-vascular system: arterial hypertension, mitral and aortic valve defects, hypertrophic cardiomyopathy.

Right ventricle. Basal diameter - ≤ 41 mm;

End-diastolic volume (EDV) RV/APT (men) ≤ 87 ml/m2, women ≤ 74 ml/m2;

End systolic volume (ESV) of the RV/PPT (men) - ≤ 44 ml/m2, women - 36 ml/m2;

The thickness of the pancreas wall is ≤ 5 mm.

Interventricular septum. The thickness of the IVS in men in mm is ≤ 10, in women - ≤ 9;

4 Valves

To assess the condition of the valves in echocardiography, parameters such as valve area and mean pressure gradient are used.

5 Vessels

Blood vessels of the heart

Pulmonary artery. Pulmonary artery (PA) diameter - ≤ 21 mm, PA acceleration time - ≥110 ms. A decrease in the lumen of the vessel indicates stenosis or pathological narrowing of the pulmonary artery. Systolic pressure ≤ 30 mm Hg, mean pressure ≤ mm Hg; An increase in pressure in the pulmonary artery that exceeds acceptable limits indicates the presence of pulmonary hypertension.

Inferior vena cava. Diameter of the inferior vena cava (IVC) - ≤ 21 mm; An increase in the diameter of the inferior vena cava can be observed with a significant increase in the volume of the right atrium (RA) and a weakening of its contractile function. This condition can occur with narrowing of the right atrioventricular orifice and with tricuspid valve (TC) insufficiency.

More detailed information about the remaining valves, large vessels, and calculations of indicators can be found in other sources. Here are some of them that were missing above:

1. Ejection fraction according to Simpson is the norm ≥ 45%, according to Teicholz - ≥ 55%. Simpson's method is used more often because it is more accurate. According to this method, the entire LV cavity is divided conditionally into a certain number of thin disks. The EchoCG operator makes measurements at the end of systole and diastole. The Teicholtz method for determining ejection fraction is simpler, but in the presence of asynergic zones in the LV, the obtained data on ejection fraction are inaccurate.
2. The concept of normokinesis, hyperkinesis and hypokinesis. Such indicators are assessed by the amplitude of the interventricular septum and the posterior wall of the LV. Normally, fluctuations of the interventricular septum (IVS) are within the range of 0.5-0.8 cm, for the posterior wall of the LV - 0.9 - 1.4 cm. If the amplitude of movements is less than the indicated figures, they speak of hypokinesis. In the absence of movement - akinesis. There is also the concept of dyskinesia - wall movement with a negative sign. With hyperkinesis, indicators exceed normal values. There may also be asynchronous movement of the LV walls, which often occurs when intraventricular conduction is impaired, atrial fibrillation(MA), artificial pacemaker.

Cardiac output: norm and causes of deviation

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. The cardiac output indicator is of important diagnostic value, 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 heart pain, 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:

A biochemical blood test and an electrocardiogram will be indicative for the doctor. 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 entered the aorta, then cardiac output was 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. A reduced 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.

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 into the slice of the circumference of all parts of the myocardium. The study is more revealing; it requires modern equipment.

Data obtained using two different formulas may differ by 10%. The data is indicative for diagnosing any disease of the cardiovascular 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%;
• a decrease in the indicator of less than 35% leads to irreversible consequences;
• a reduced rate may be an 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 the left ventricle, regardless of whether the heart is currently busy 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%, a reduced rate is read as 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 for the initial stage of heart failure and pushes out blood with greater force.

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

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 cardiomyopathy leads 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, endocarditis);
• 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.

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 stool;
• 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, normsm.

It is important to evaluate not each indicator separately, but the overall clinical picture. If there is a deviation from the norm up or down in only one indicator, additional research will be required to determine the cause.

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 is drug therapy, sometimes surgical intervention.

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 intoxication.

Heart failure is treated not only with pills. The patient must control the 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, and Digoxin are prescribed. 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. An artificial heart driver can be installed for arrhythmia. 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. Sports activities.
3. Proper nutrition.
4. Rejection of bad habits.
5. Outdoor recreation.
6. Relief from stress.

Causes of abnormal ejection fraction and treatment methods

Cardiac ejection fraction (EF) is a value that determines the efficiency of the heart. Basically, this indicator is characterized by the amount of blood that, during the contraction period, is pushed into the aortic space by the left ventricle. In a calm state, the ventricle contains blood from the left atrium inside; at the moment of contraction, it throws part of it into the vessels. Left ventricular ejection fraction is the percentage ratio of the amount of blood pushed into the aorta to the volume of blood in the left ventricle, which is in a relaxed state. The volume of blood ejected, expressed as a percentage, is called the ejection fraction.

Such a concept as ejection fraction determines the functionality of the left ventricle, since it ejects blood into the systemic circulation. As the ejection fraction decreases, heart failure develops.

Indications for prescribing ejection fraction studies may include patient complaints:

• heartache;
• chest pain;
• interruptions in heart activity;
• tachycardia;
• fainting and dizziness;
• weakness;
• decreased performance;
• swelling of the limbs.

First, as a rule, an electrocardiogram and blood test are prescribed, then Holter monitoring of the electrocardiogram, bicycle ergometry and ultrasound of the heart may be prescribed.

How is PV calculated?

Ejection fraction is easy to calculate and contains sufficient information about the ability of the myocardium to contract. The use of drugs in the treatment of patients with cardiovascular failure depends on this indicator. Studies such as cardiac ultrasound with Doppler sonography are widely used to determine the value of left ventricular ejection fraction.

The ejection fraction can be determined using the Teicholtz formula or the Simpson method:

• Using M-modal echocardiography (parasternal access), the ventricular ejection fraction is determined using the Teichholz formula (Teichholz L. E., 1976). A small part of the ventricle at the base is subject to study; its length is not taken into account. The formula gives inaccurate results when examining patients with ischemia, when there are areas with impaired local contractility. Using information about the systolic and diastolic volume of the left ventricle and its dimensions, the program automatically calculates the result. The method is used on outdated equipment.
• Quantitative two-dimensional echocardiography (apical access) is a method that is more accurate compared to the previous one. In modern ultrasound diagnostic clinics, they use the Simpson algorithm (Simpson J. S., 1989) or, as it is also called, the disc method. All significant areas of the myocardium are included in the field of view during the study.

The difference between ejection fraction studies can vary by up to 10%.

Normal fraction emission

At the moment of contraction, the human heart pushes more than 50% of the blood into the blood supply. Heart failure occurs when the level of ejection fraction decreases. Progressive failure of myocardial contractile function may serve as the basis for the development of other changes in the internal organs.

The ejection fraction rate is 55–70%. At 40–55% we can say that EF is below normal. Interruptions in the functioning of the heart occur when the indicator drops to 35%: heart failure occurs. To prevent a decrease in EF, it is recommended to visit a cardiologist at least once a year, and for people over forty, this is a prerequisite. When examining patients with heart pathologies, it is important to determine the minimum value of the left ventricular ejection fraction. The choice of treatment tactics for the patient depends on this.

Why might the EF level be overestimated?

If the test results show an indicator of 60% or more, this indicates an overestimated level of ejection fraction. The highest value can reach 80%; the left ventricle is simply unable to throw more blood into the vessels due to its characteristics. Typically, such results are typical for healthy people without other heart pathologies. And for athletes with a trained heart, in whom the heart muscle, contracting with significant force, is able to push out more blood than usual.

Cardiomyopathy or hypertension can trigger the development of myocardial hypertrophy. In such patients, the heart muscle can still cope with heart failure and compensates for it, trying to expel blood into the systemic circulation. This can be judged by observing an increase in left ventricular EF.

As heart failure progresses, the ejection fraction slowly decreases. For patients suffering from chronic heart failure, periodic echocardioscopy is extremely important to monitor the decrease in EF.

Ways to increase low EF

Chronic heart failure - main reason disturbances in the systolic (contractile) function of the myocardium, and therefore a decrease in the ejection fraction. The development of CHF is promoted by:

1. Cardiac ischemia is a reduced amount of blood in the coronary vessels that supply the heart with oxygen.
2. Myocardial infarction, its large focality and transmurality. The end result is the replacement of healthy heart cells with scars that are unable to contract.
3. Diseases caused by irregular heart rhythm due to improper contraction.
4. Cardiomyopathy is stretching or enlargement of the heart muscle. Develops as a result of hormonal imbalances, hypertension, and heart disease.

Poor health, shortness of breath, swelling of the extremities indicate a low ejection fraction. How to increase the volume of fraction emission? Today, in modern medicine, therapy is in first place among the ways to increase EF. Patients are often observed on an outpatient basis, where the state of the heart, cardiovascular system and drug treatment are examined.

The doctor often prescribes diuretics that can reduce the amount of blood that circulates in the system, and ultimately the load on the heart. As well as glycosides, ACE inhibitors or beta-blockers, which reduce the heart’s need for oxygen, increase performance and reduce the energy requirement of the heart muscle.

In extreme cases, due to the danger of death, such as heart or valve defects, surgery is performed. In all other cases, therapy is indicated. Operations have been developed to restore blood flow in the coronary vessels in case of coronary heart disease and valve defects. During the operation, the valves are resected and prosthetics are performed. Thus, normalization of the rhythm is achieved, arrhythmia and fibrillation disappear.

Cardiovascular surgery requires the professionalism and experience of surgeons, so operations are performed in cardiology centers.

Prevention of low EF

If the patient does not have a predisposition to heart disease, then the value of the left ventricular ejection fraction can be successfully maintained within the normal range.

To prevent normal ejection fraction, doctors recommend:

1. Sports (aerobics), light exercise.
2. Don't carry heavy things, go to the gym.
3. Quitting alcohol and smoking.
4. Healthy lifestyle.
5. Eating foods rich in iron.
6. Reduce salt intake.
7. Drink 1.5–2 liters of water per day.
8. Diet.

According to statistics from the 20th century, heart disease mainly affected people in old age. In the 21st century, these pathologies have become significantly younger. The risk group includes residents of megacities who live in conditions with high levels of vehicle exhaust and low levels of oxygen.

What is cardiac ejection fraction?

Today, due to poor ecology, many people have unstable health. This applies to all organs and systems in the human body. Therefore, modern medicine has expanded its methods for studying pathological processes. Many patients wonder what cardiac ejection fraction (EF) is. The answer is simple, this condition is the most accurate indicator that can determine the level of performance of the human cardiac system. More precisely, the strength of the muscle at the moment of impact of the organ.

Definition

The cardiac ejection fraction can be defined as the percentage of the amount of blood that passes through the vessels during the systolic state of the ventricles.

For example, at 100 ml, 65 ml of blood enters the vascular system, respectively, the cardiac output of the heart fraction is 65%. Any deviations in one direction or another are an indicator of the presence of heart disease, requiring immediate treatment.

Healthy heart and heart failure

In most cases, measurements are taken from the left ventricle because blood flows from it into the systemic circulation. When there is a decrease in the amount of distilled contents, this is usually a consequence of heart failure.

Diagnostics such as left ventricular ejection fraction are prescribed to patients who have:

• Intense chest pain.
• Systematic failures in the functioning of the organ.
• Shortness of breath and cardiac tachycardia.
• Frequent fainting and dizziness.
• Weakness and fatigue.
• Decreased performance.

In most cases, during the examination, an ultrasound (ultrasound) of the heart and a cardiogram are prescribed. These studies provide output levels in the left and right side of the heart. Such diagnostics are quite informative and accessible to all patients.

Causes

In fact, the causes of low cardiac ejection fraction are malfunctions of the organ. Heart failure is considered a condition that occurs as a result of long-term disruption of the system. Inflammatory diseases and malfunctions can lead to this pathology immune system, genetic and metabolic predisposition, pregnancy and much more.

Often the cause of heart failure is the presence of organ ischemia, a previous heart attack, hypertensive crisis, combination of hypertension and ischemic heart disease, valvular malformations.

Symptoms

Most often, symptoms of a reduced ejection fraction of the heart manifest themselves in a malfunction of the organ. To clarify the diagnosis, you need to undergo a detailed examination and undergo a lot of tests.

If necessary, the doctor prescribes a series pharmacological drugs, which can cause increased heart performance. This applies to patients of any age category from infants to elderly patients.

Frequent shortness of breath and pain in the heart - cause cardiac ejection fraction disorders

Treatment

The most popular methods of treating low cardiac ejection fraction are the use of medications. In cases where the main cause of this pathological process is heart failure, treatment is selected for the patient taking into account the age and characteristics of the body.

Dietary restrictions are almost always recommended, as well as a reduction in fluid intake. You need to drink no more than 2 liters per day, and then only clean, non-carbonated water. It is worth noting that for the entire period of treatment it is necessary to almost completely avoid eating salt. A number of diuretics, ACE inhibitors, digoxin and beta-blockers are prescribed.

All of the above agents significantly reduce the volume of circulating blood masses, which accordingly reduces the level of functioning of the organ. A number of other drugs can reduce the body's need for oxygen, while at the same time making its functionality more effective and at the same time less expensive. In some advanced cases, surgical intervention is used to restore blood flow in all coronary vessels. A similar method is used for ischemic disease.

In cases of severe defects and pathological processes, only surgery in combination with drug therapy is used as treatment. If necessary, artificial valves are installed that can prevent cardiac arrhythmia and many other cardiac failures, including fibrillation. Instrumental methods are used as a last resort, when drug therapy is unable to eliminate certain problems in the functioning of the cardiac system.

Norm

To determine the natural rate of cardiac ejection fraction, a special Simpson or Teicholz table is used. It is worth noting that only after a complete examination the doctor can establish an accurate diagnosis and accordingly prescribe the most adequate treatment.

The presence of any pathological processes in the cardiac system is due to a regular lack of oxygen (oxygen starvation) and nutrients. In such cases, the heart muscles need support.

As a rule, all data is calculated using special equipment that can detect the presence of deviations. Most modern specialists, when using ultrasound diagnostics, prefer the Simpson method, which gives the most accurate results. The Teicholz formula is used less frequently. The choice in favor of one or another diagnostic method is made by the attending physician based on the test results and the patient’s health condition. The ejection fraction of the heart must be normal at any age, otherwise failures can be considered a pathology.

The exact result of both methods is considered to be in the range of 50-60%. A slight difference between them is allowed, but not more than 10%. Ideally, the normal heart fraction in adults is exactly this percentage level. Both methods are considered highly informative. As a rule, according to the Simpson table, the outlier is 45%, and according to Teicholz - 55%. When the values ​​decrease to 35-40%, this is evidence of an advanced degree of heart failure, which can be fatal.

Normally, the heart should push out at least 50% of the blood it pumps. When this level decreases, heart failure occurs; in most cases it is progressive, which affects the development of pathological processes in many internal organs and systems.

The normal ejection fraction in children varies from 55 to 70%. If its level is below 40-55%, then this already indicates a malfunction of the heart. To prevent such deviations, it is necessary to conduct a preventive examination by a cardiologist.

Left ventricular ejection fraction of the heart: norms, reasons for low and high, how to increase

What is ejection fraction and why does it need to be assessed?

Cardiac ejection fraction (EF) is an indicator that reflects the volume of blood ejected by the left ventricle (LV) at the time of its contraction (systole) into the lumen of the aorta. EF is calculated based on the ratio of the volume of blood ejected into the aorta to the volume of blood present in the left ventricle at the moment of its relaxation (diastole). That is, when the ventricle is relaxed, it contains blood from the left atrium (end-diastolic volume - EDV), and then, contracting, it pushes part of the blood into the lumen of the aorta. This part of the blood is the ejection fraction, expressed as a percentage.

The ejection fraction of blood is a value that is technically easy to calculate, and which has a fairly high information content regarding myocardial contractility. The need to prescribe cardiac medications largely depends on this value, and also determines the prognosis for patients with cardiovascular failure.

The closer to normal values ​​a patient’s LV ejection fraction is, the better his heart contracts and the more favorable the prognosis for life and health. If the ejection fraction is much lower than normal, it means that the heart cannot contract normally and supply blood to the entire body, and in this case, the heart muscle should be supported with the help of medications.

How is ejection fraction calculated?

This indicator can be calculated using the Teicholtz or Simpson formula. The calculation is carried out using a program that automatically calculates the result depending on the final systolic and diastolic volume of the left ventricle, as well as its size.

The calculation using the Simpson method is considered more successful, since according to Teicholz, small areas of the myocardium with impaired local contractility may not be included in the research slice during two-dimensional Echo-CG, while with the Simpson method, larger areas of the myocardium fall into the circle slice.

Despite the fact that the Teicholz method is used on outdated equipment, modern ultrasound diagnostic rooms prefer to evaluate the ejection fraction using the Simpson method. The results obtained, by the way, may differ - depending on the method, by values ​​within 10%.

Normal EF values

The normal value of ejection fraction differs among different people, and also depends on the equipment on which the study is carried out, and on the method by which the fraction is calculated.

The average values ​​are approximately 50-60%, the lower limit of normal according to the Simpson formula is at least 45%, according to the Teicholz formula - at least 55%. This percentage means that exactly this amount of blood per heartbeat must be pushed by the heart into the lumen of the aorta to ensure adequate delivery of oxygen to the internal organs.

35-40% speak of advanced heart failure; even lower values ​​are fraught with fleeting consequences.

In children in the neonatal period, EF is at least 60%, mostly 60-80%, gradually reaching normal levels as they grow.

Of the deviations from the norm, more often than an increased ejection fraction, there is a decrease in its value due to various diseases.

If the indicator is reduced, it means that the heart muscle cannot contract sufficiently, as a result of which the volume of expelled blood decreases, and the internal organs, and, first of all, the brain, receive less oxygen.

Sometimes in the conclusion of echocardioscopy you can see that the EF value is higher than the average (60% or more). As a rule, in such cases the figure is no more than 80%, since the larger volume of blood in the left ventricle due to physiological characteristics will not be able to expel into the aorta.

As a rule, high EF is observed in healthy individuals in the absence of other cardiac pathology, as well as in athletes with trained cardiac muscle, when the heart contracts with greater force with each beat than in an ordinary person and expels a greater percentage of the blood contained in it into the aorta.

In addition, if the patient has LV myocardial hypertrophy as a manifestation of hypertrophic cardiomyopathy or arterial hypertension, an increased EF may indicate that the heart muscle can still compensate for incipient heart failure and strives to expel as much blood as possible into the aorta. As heart failure progresses, EF gradually decreases, so for patients with clinically manifested CHF it is very important to perform echocardioscopy over time so as not to miss a decrease in EF.

Causes of reduced cardiac ejection fraction

The main cause of impaired systolic (contractile) myocardial function is the development of chronic heart failure (CHF). In turn, CHF occurs and progresses due to diseases such as:

• Coronary heart disease is a decrease in blood flow through the coronary arteries, which supply oxygen to the heart muscle itself,
• Previous myocardial infarctions, especially large-focal and transmural (extensive), as well as repeated ones, as a result of which normal muscle cells hearts after a heart attack are replaced by scar tissue that does not have the ability to contract - post-infarction cardiosclerosis is formed (in the description of the ECG can be seen as the abbreviation PICS),

Decreased EF due to myocardial infarction (b). Affected areas of the heart muscle cannot contract

Most common cause decreased cardiac output are acute or previous myocardial infarctions, accompanied by a decrease in global or local contractility of the left ventricular myocardium.

Symptoms of reduced ejection fraction

All symptoms that may suggest a decrease in the contractile function of the heart are caused by CHF. Therefore, the symptoms of this disease come first.

However, according to the observations of practicing ultrasound diagnostic doctors, the following is often observed: in patients with severe signs of CHF, the ejection fraction remains within the normal range, while in people with no obvious symptoms, the ejection fraction is significantly reduced. Therefore, despite the absence of symptoms, patients with cardiac pathology must undergo echocardioscopy at least once a year.

So, symptoms that suggest a violation of myocardial contractility include:

1. Attacks of shortness of breath at rest or during physical exertion, as well as when lying down, especially at night,
2. The load that provokes the occurrence of shortness of breath attacks can be different - from significant, for example, walking long distances (we are sick), to minimal household activity, when it is difficult for the patient to perform the simplest manipulations - cooking, tying shoelaces, walking to the next room, etc. d,
3. Weakness, fatigue, dizziness, sometimes loss of consciousness - all this indicates that the skeletal muscles and brain receive little blood,
4. Swelling on the face, legs and feet, and in severe cases - in the internal cavities of the body and throughout the body (anasarca) due to impaired blood circulation through the vessels of the subcutaneous fat, in which fluid retention occurs,
5. Pain in the right half of the abdomen, an increase in abdominal volume due to fluid retention in the abdominal cavity (ascites) - occurs due to venous stagnation in the hepatic vessels, and long-term stagnation can lead to cardiac cirrhosis of the liver.

In the absence of proper treatment for systolic myocardial dysfunction, such symptoms progress, increase and become increasingly difficult for the patient to tolerate, therefore, if even one of them occurs, you should consult a general practitioner or cardiologist.

When is treatment for reduced ejection fraction required?

Of course, no doctor will suggest that you treat a low reading obtained from a heart ultrasound. First, the doctor must identify the cause of the reduced EF, and then prescribe treatment for the causative disease. Depending on it, treatment may vary, for example, taking nitroglycerin drugs for coronary artery disease, surgical correction of heart defects, antihypertensive drugs for hypertension, etc. It is important for the patient to understand that if there is a decrease in the ejection fraction, it means that heart failure is really developing and it is necessary to follow the doctor’s recommendations for a long time and scrupulously.

How to increase reduced ejection fraction?

In addition to drugs that affect the causative disease, the patient is prescribed drugs that can improve myocardial contractility. These include cardiac glycosides (digoxin, strophanthin, corglycon). However, they are prescribed strictly by the attending physician and their independent uncontrolled use is unacceptable, since poisoning may occur - glycoside intoxication.

To prevent volume overload of the heart, that is, excess fluid, it is recommended to follow a diet limiting table salt to 1.5 grams per day and limiting fluid intake to 1.5 liters per day. Diuretic drugs (diuretics) are also successfully used - diacarb, diuver, veroshpiron, indapamide, torasemide, etc.

To protect the heart and blood vessels from the inside, drugs with so-called organoprotective properties - ACE inhibitors - are used. These include enalapril (Enap, Enam), perindopril (Prestarium, Prestans), lisinopril, captopril (Capoten). Also among drugs with similar properties, ARA II inhibitors are widely used - losartan (Lorista, Lozap), valsartan (Valz), etc.

The treatment regimen is always selected individually, but the patient must be prepared for the fact that the ejection fraction does not return to normal immediately, and symptoms may persist for some time after the start of therapy.

In some cases, the only method to cure the disease that caused the development of CHF is surgery. Surgeries may be needed to replace valves, install stents or shunts on coronary vessels, install a pacemaker, etc.

However, in cases of severe heart failure (functional class III-IV) with extremely low ejection fraction, surgery may be contraindicated. For example, a contraindication to mitral valve replacement is a decrease in EF of less than 20%, and to implantation of a pacemaker - less than 35%. However, contraindications to operations are identified during an in-person examination by a cardiac surgeon.

Prevention

The preventive focus on preventing cardiovascular diseases leading to low ejection fraction remains especially relevant in the modern environmentally unfavorable environment, in the era of a sedentary lifestyle in front of computers and eating low-health foods.

Even based on this, we can say that frequent recreation outside the city in the fresh air, healthy eating, adequate physical activity (walking, light jogging, exercises, gymnastics), giving up bad habits - all this is the key to long-term and proper functioning of the cardiovascular system with normal contractility and fitness of the heart muscle.