Reduced values impact indicators(eg, volume, work, strength and their indices adjusted for body surface area) are often associated with reduced myocardial contractility, but since these parameters are significantly dependent on pre- and afterload, these two variables also need to be determined. The dependence of stroke volume on preload was described more than 100 years ago by Otto Frank and E.N. Starling (since then it has been called the Frank-Starling mechanism). Based on the relationship between preload and SV or systolic work, a ventricular function curve can be constructed using the systolic work values ​​at different levels preload, which can be expressed by ventricular EDV, EDP or end-diastolic wall tension.
On preload may be affected by volume loading (elevating the legs, infusing large volumes of fluid) or reducing it (occlusion with a balloon catheter of the vena cava).

LV afterload can be calculated from mean or end-systolic arterial or ventricular pressure or, more accurately, by calculating mean systolic, peak systolic and end-systolic wall stress. The most reliable method for determining LV contractility is to determine the pressure-to-volume ratio at end-systole (PSV/CVR; maximum elasticity), because this indicator almost independent of pre- and afterload.

Slope of a given line ratio denotes LV contractility. The use of ventricular function waveforms in assessment is limited by the technical difficulties of making measurements in patients, changes that occur during the time required to take measurements, and varying interpretation because interpretation depends on the patient's sex, age, and afterload. Changes in RV DN can affect the position of the interventricular septum (IVS) and alter LV diastolic pressure, thereby altering the position of the ventricular function curve.

Ejection fraction of the left ventricle

There are several indexes global systolic function and LV contractility. Each index depends to some extent on pre- and afterload and can vary depending on the volume of the ventricle and myocardial mass. An important feature of their use in clinical practice is their ease of use.

Ejection fraction- this is the ratio of MA to KDO. In most cases, it is calculated by the formula: EF = (EDV - ESV) / ​​EDV x 100 (%), where EF is the ejection fraction, EDV is the end-diastolic volume, ESV is the end-systolic volume.

Normal LVEF value- 55-75% with cineangiography and echocardiography, but may be lower when determined by radionuclide angiography (45-65%). There are no gender differences observed. However, with age there is a tendency for EF to decrease. A sharp increase in afterload, as with a sharp increase in pressure load, leads to a decrease in EF to 45-50% in healthy people. However, the decrease in LVEF< 45% свидетельствует об ограниченной функции миокарда, независимо от условий нагрузки.

Wide application of PV in clinical practice is the result of a number of factors: ease of calculation, reproducibility using various imaging modalities, and extensive literature evidence supporting its clinical utility. This indicator has important prognostic significance (both short- and long-term) in patients with various CVDs. However, it has its limitations, since it depends not only on myocardial contractility, but also on pre- and afterload, as well as on heart rate and contraction synchrony. This parameter is also global, and regional differences in contractility appear to be averaged.

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.

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 peripheral system blood vessels 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 condition of cardio-vascular system during operations, monitoring the patient’s condition 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 cardiac ejection fraction is a clinical symptom in itself, it has its own characteristic features manifestations:

• increased breathing rate, possible attacks of suffocation;
• pre-fainting states and fainting;
• “floaters” or “darkening” in the eyes;
• increase in heart rate to tachycardia levels;
• swelling lower limbs(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 for low cardiac ejection fraction is aimed at stabilizing pathological processes, and occurs within standard therapy a disease or condition that causes a decrease in myocardial performance, and correction of left ventricular failure. In addition to hypertensive drugs, 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.

The concept of “ejection fraction” is of interest not only to specialists. Any person who is undergoing examination or treatment for heart and vascular diseases may encounter the concept of ejection fraction. Most often, the patient hears this term for the first time while undergoing an ultrasound examination of the heart - dynamic echography or X-ray contrast examination. In Russia, thousands of people require imaging examinations every day. More often carried out ultrasonography heart muscle. It is after such an examination that the patient is faced with the question: ejection fraction - what is the norm? You can get the most accurate information from your doctor. In this article we will also try to answer this question.

Heart diseases in our country

Diseases of the cardiovascular system in civilized countries are the first cause of death for the majority of the population. In Russia, coronary heart disease and other diseases of the circulatory system are extremely widespread. After 40 years, the risk of getting sick becomes especially high. Risk factors for cardiovascular problems are male gender, smoking, sedentary lifestyle, carbohydrate metabolism disorders, high cholesterol, high blood pressure and some others. If you have several risk factors or complaints from the cardiovascular system, then it is worth contacting for examination medical care to the doctor general practice or a cardiologist. Using special equipment, the doctor will determine the size of the left ventricular ejection fraction and other parameters, and, therefore, the presence of heart failure.

What examinations can a cardiologist prescribe?

The doctor may be alerted by the patient's complaints of pain in the heart, pain behind the sternum, interruptions in heart function, rapid heartbeat, shortness of breath during exercise, dizziness, fainting, swelling in the legs, fatigue, decreased performance, and weakness. The first tests are usually an electrocardiogram and a biochemical blood test. Next, Holter monitoring of the electrocardiogram, bicycle ergometry and ultrasound examination of the heart can be performed.

What studies will show ejection fraction?

Ultrasound examination of the heart, as well as radiopaque or isotope ventriculography will help obtain information about the ejection fraction of the left and right ventricles. Ultrasound examination is the cheapest, safest and least burdensome for the patient. Even the simplest ultrasound machines can give an idea of ​​cardiac ejection fraction.

Cardiac ejection fraction

Ejection fraction is a measure of how much work the heart does with each beat. The ejection fraction is usually called the percentage of the volume of blood ejected into the vessels from the ventricle of the heart during each contraction. If there were 100 ml of blood in the ventricle, and after the heart contracted, 60 ml entered the aorta, then we can say that the ejection fraction was 60%. When you hear the term “ejection fraction,” we are usually talking about the function of the left ventricle of the heart. Blood from the left ventricle enters the systemic circulation. It is left ventricular failure that most often leads to the development of the clinical picture of heart failure. The ejection fraction of the right ventricle can also be assessed with ultrasound examination of the heart.

Ejection fraction - what is the norm?

A healthy heart, even at rest, pumps more than half of the blood from the left ventricle into the vessels with each beat. If this figure is significantly lower, then we are talking about heart failure. This condition can be caused by myocardial ischemia, cardiomyopathy, heart defects and other diseases. So, the normal left ventricular ejection fraction is 55-70%. A value of 40-55% indicates that the ejection fraction is below normal. An indicator of less than 40% indicates the presence of heart failure. If the left ventricular ejection fraction decreases to less than 35%, the patient is at high risk of life-threatening interruptions in cardiac function.

Low ejection fraction

Now that you know your ejection fraction standards, you can evaluate how your heart is working. If your left ventricular ejection fraction is lower than normal on echocardiography, you will need to see your doctor immediately. It is important for the cardiologist not only to know that heart failure exists, but also to find out the cause of this condition. Therefore, after an ultrasound examination, other types of diagnostics can be carried out. Low ejection fraction may be a predisposing factor for feeling unwell, swelling and shortness of breath. Currently, a cardiologist has tools to treat diseases that cause low ejection fraction. The main thing is constant outpatient monitoring of the patient. In many cities, specialized cardiology clinics have been organized for free dynamic monitoring of patients with heart failure. A cardiologist may prescribe conservative treatment with pills or surgical procedures.

Methods for treating low cardiac ejection fraction

If the cause of low cardiac ejection fraction is heart failure, then appropriate treatment will be required. The patient is recommended to limit fluid intake to less than 2 liters per day. The patient will also have to stop using table salt in food. The cardiologist may prescribe medicines: diuretics, digoxin, ACE inhibitors or beta blockers. Diuretic medications somewhat reduce the volume of circulating blood, and therefore the amount of work done by the heart. Other drugs reduce the oxygen demand of the heart muscle, making its function more effective, but less expensive.

Plays an increasingly important role surgery reduced cardiac ejection fraction. Operations have been developed to restore blood flow in the coronary vessels during coronary disease hearts. Surgery is also used to treat severe heart valve defects. According to indications, artificial cardiac pacemakers can be installed to prevent arrhythmia in the patient and eliminate fibrillation. Cardiac interventions are long-term, difficult operations that require extremely high qualifications from the surgeon and anesthesiologist. Therefore, such operations are usually performed only in specialized centers in large cities.

The normal cardiac ejection fraction is different for each person. This value shows how much blood leaves the ventricles of the heart into the lumen of the blood vessels (aorta and pulmonary artery). The cardiac ejection fraction is calculated separately for the right and left ventricles. Greater information is provided by the left ventricular ejection fraction, since it is responsible for saturating all tissues and organs with nutrients and oxygen.

Calculation methods

To calculate left ventricular ejection fraction, it is important to know the volume of blood that exits into the aorta and the amount of blood that is in the left ventricle during its diastole (end-diastolic volume). The indicator value is expressed as a percentage.

Using the data obtained, the doctor analyzes the state of the myocardium and its contractility. Based on this indicator, the specialist decides on the prescription of cardiac medications and determines the prognosis for patients with heart failure. The closer to normal the LVEF value is, the greater the patient’s chances for a full life and a favorable prognosis. This means that his heart contracts fully, providing the body with blood in full.

There are 2 ways to calculate the indicator: using the Teicholz or Simpson formula. These techniques are automated. The value is calculated taking into account the final systolic and diastolic volumes of the left ventricle and its dimensions. Simpson's method is more often used because it is more accurate. With this method of calculation, almost all significant areas of the myocardium are included in the study slice.

Indicators normally differ from different people. This is due to the use of different equipment and methods for calculating the fraction. On average, the normal ejection fraction is 50-60% (according to the Simpson formula, the lower limit of normal is 45%, and according to the Teicholz formula - 55%). It is this part of the blood that can adequately provide blood supply to the organs and systems of the body.

When the emission value is 35-45%, the doctor diagnoses “advanced form of deficiency.” Lower values ​​of the indicator are life-threatening.

In newborns, EF is 60-80%, gradually reaching normal standards.

Some individuals may experience an increase in fraction values ​​(80% or higher). Often we are talking about healthy people without any cardiac pathology or athletes with a trained heart. In such people, the heart contracts with great force, therefore expelling more blood into the aorta.

VWF can sometimes manifest itself in a pathological aspect. This condition can be observed with hypertrophic changes in the myocardium (with hypertension, hypertrophic cardiomyopathy). This manifestation of cardiac work indicates compensated cardiac activity. As EF deficiency progresses, it may decrease, which indicates a poor prognosis of the disease. Such a study is very important for patients with CHF, because it helps to monitor the condition of their heart and blood vessels.

Why is the value dropping?

A decrease in systolic work of the heart is a consequence of chronic heart failure. This disease develops due to:

1. 1. Coronary heart disease. At the same time, blood flow to the heart muscle through the arteries of the heart sharply decreases.
2. 2. Myocardial infarction (especially large-focal, transmural, repeated). After a heart attack, some are normal muscle cells the hearts are replaced by scars that are unable to contract. Cardiosclerosis develops in a similar way after a heart attack. These areas remain intact.
3. 3. Disorders of cardiac rhythm and conduction, which persist for a long time and often recur. Due to such irregular, irregular contractions, the heart muscle wears out quite quickly.
4. 4. Cardiomyopathies. These are specific disorders of the structure of the heart. They occur due to enlargement or stretching of the heart muscle. The pathology is often caused by hormonal imbalance, prolonged hypertension, heart defects, and chronic infection in the body.

In 8 out of 10 cases, cardiac output drops sharply after myocardial infarction, which is accompanied by a decrease in left ventricular contractility.

Symptoms of the disease

A decrease in the contractility of the heart is caused by heart failure. In this case, the following symptoms are observed:

• development of shortness of breath at rest, during physical exertion, while lying down (especially during night sleep);
• a gradual decrease in the intensity of the load to cause shortness of breath (in severe cases, the simplest manipulations - cooking, walking around the room can provoke attacks);
• general weakness, malaise, fast fatiguability, dizziness, possible episodes of loss of consciousness;
• swelling of the body, face, legs and feet, development of anasarca (fluid accumulation in internal organs and cavities);
• pain in the right half of the abdomen, an increase in its volume.

Without the right adequate and timely treatment disruption of the systolic functioning of the heart progresses, increases and can disrupt the normal existence of a person. A decrease in heart performance is a consequence of the disease. Therefore, before therapy, it is important to determine the cause of the pathology.

For example, in case of ischemic heart disease, Nitroglycerin is prescribed, the defects are removed surgically, and hypertension is controlled by taking antihypertensive drugs. The patient must clearly understand that a violation of the pumping function of the heart indicates a deterioration in his condition, the development of heart failure, which has dangerous consequences and complications.

/ 30.07.2018

Low ejection fraction. Exercises to treat heart failure. Risk factors, symptoms.

Before diagnosing a patient with chronic heart failure, the doctor conducts diagnostics with the obligatory determination of such an indicator as the ejection fraction. It reflects the amount of blood that the left ventricle pushes into the lumen of the aorta at the time of its contraction. That is, through such a study it is possible to find out whether the heart is effectively coping with its work or whether there is a need to prescribe cardiac medications.

The principle of measurement is this: if cardiac output is higher, then the cold returns to the site faster and becomes less diluted. Conversely, if cardiac output is low, it will take longer for the cold to reach the measurement site, and after that the cold will be more dilute. Calibration of the method was carried out by simultaneous measurements using other methods. The method of measuring thermodilution can be considered invasive to the extent that it requires the presence of a Swan-Ganz catheter in the right side of the heart and lungs.

However, it does not indicate catheterization, and is primarily used where a catheter has been inserted for other reasons, particularly to measure blood pressure. The accuracy of the method is not ideal, so several measurements are used sequentially and the result is averaged.

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.

Note: In this section, the blood that enters the lungs through the pulmonary arteries will be called venous. The blood that flows into the pulmonary veins and then into the systemic arteries will be called arterial. Fick's principle is a simple application of the law of conservation of matter.

When we enter into a relationship, we receive. Thus, cardiac output can be defined as. In this derivation we used the inflows and outflows of oxygen quantity. Alternatively, we could use oxygen mass fluxes. Sometimes volumetric oxygen flows are also used. This expression is believed to represent the amount of oxygen that flows in and out of the blood if the oxygen is in a gaseous state.

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 the internal organs do not receive the required amount of oxygen and nutrients from the blood, which means the heart muscle needs to be supported somehow.

Although this classical method is relatively accurate, it is rarely used for its invasiveness. Fick's principle can be used for substances other than oxygen. This procedure avoids the need for arterial blood collection. Unfortunately, the method fails in the presence of poorly ventilated areas of the lungs, which, of course, can in extreme cases lead to pathological short circuits in the lungs.

This procedure can avoid the need for troublesome central venous catheterization. The measurement occurs in such a way that the patient begins to breathe a mixture containing the substance. The partial pressure of this substance in arterial blood is then measured. The advantage of this method is that when the gas is not normally present in the air, the venous flow of this substance is zero before the measurement begins.

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 characterized by a fairly high level of 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.

And cardiac output after treatment is calculated as. This method also bypasses the need for central venous catheterization. Summary. Non-invasive or low-invasive methods of heart rate measurement, based on the use of the Fick principle, may provide an accurate and inexpensive method for measuring heart rate in the future. The potential use of oxygen and carbon dioxide has so far encountered problems with the accuracy of transfer of partial pressures to concentrations in which it depends, for example, on the influence of pH, the mutual interaction of both gases with hemoglobin, etc. Lung heterogeneity can also cause problems.

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 conduction.
4. Cardiomyopathy. It consists of enlarging or lengthening the heart muscle, which is caused by hormonal imbalance, prolonged hypertension, and heart defects.

Magnetic resonance: The resonant properties of protons in the nucleus change with speed. Magnetic resonance can be used as an accurate way to measure aortic flow. The method is expensive and is used only experimentally. Mathematical analysis of the pulse wave: The shape and amplitude of the pulse wave depend on cardiac output. The pulse wave is measured either using a classic inflatable cuff or a sensor that adheres to the skin at the site of the artery. Therefore, mathematical analysis of this wave can be the value of cardiac output.

The problem is that the shape of the pulse wave also strongly depends on the properties of the arteries. For example, in older people, where the elasticity of the aorta and its elastic effect are lost, systolic pressure usually increases, but diastolic pressure remains normal. This method may be useful after calibration on a person using another method for continuous heart rate monitoring.

Symptoms of the disease

The diagnosis of “reduced ejection fraction” can be made based on symptoms characteristic 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.

Chest impedance measurement: electrical resistance chest can be measured with several chest electrodes. Resistance changes as heart rate changes due to changes in blood volume in the heart and can therefore be used to calculate heart rate and subsequent cardiac output. The method is cheap and non-invasive, but, unfortunately, inaccurate.

Acute myocardial ischemia of the left ventricular muscle fibers worsens the possibility of spasm and compliance. These changes can be reversible if the ischemia does not last too long and does not end with ischemic necrosis of the fibers. IN last years He announced a number of observations indicating that ultimately the fate of the muscle fibers covered in acute ischemia, acute myocardial infarction, is decided within a few, perhaps even several hours after the onset of chest pain. It is therefore possible that appropriate actions during this period - at least in some patients - will limit the extent of infarct necrosis.

Often attacks occur at night in a lying position. Loss of consciousness, weakness, fatigue and dizziness may mean that the brain and skeletal muscles are experiencing a lack of blood.

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 fabrics. 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.

Additional loads, increasing the oxygen demand of myocardial necrosis, alarmingly increase within the infarction, and can have an adverse effect on the fate of the patient, even when their effect is inconsistent. When the fibers shrink, a healthy area covered by ischemia does not shrink, but rather, under the influence of increasing pressure in the chamber, the bulges act as a kind of valve. An increase in the residual volume after shrinkage, and a violation of the vulnerability of the left ventricle, due to its acute ischemia, leads to an increase in the end-diastolic pressure of the left ventricle, and secondly, increased pressure in the left atrium and pulmonary veins disorganized to it, exceeding the critical value of this pressure predisposes to the formation of pulmonary edema Contrary to expectation, both of these complications do not always occur simultaneously: they were seen in both cases. isolated pulmonary edema and shock are isolated cases. The simultaneous occurrence of shock and pulmonary edema during an acute infarction usually indicates very serious damage to the left ventricle and is subject to a significantly higher mortality rate than either of these complications in isolated form.

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.

If the hemodynamic consequences of a heart attack develop less turbulently, they take the form of subacute or chronic left ventricular failure, and in extreme cases - the so-called character. low output heart syndrome. The latter group sometimes causes severe shock and heart attacks in cases where therapeutic intervention temporarily preserves the patient's life, but does not restore normal blood circulation. The boundaries separating the above clinical fluid syndromes from each other are clear to their general pathogenesis.

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.

Section of hemodynamic monitoring, exploitation of the physiological compensatory mechanism that makes the left ventricle enlarged causes filling pressure - within certain limits - to increase stroke volume. Insufficient venous supply caused by absolute or relative hypovolemia can disrupt the functioning of the mechanism. The only chance of improvement in such cases is to increase cardiac contractility by pharmacological means or by improving blood supply to the area affected by acute ischemia.

In patients with acute myocardial infarction, hemodynamic balance is often precarious. This balance can easily lead to arrhythmic complications, dangerous acceleration or dangerous slowdown of ventricular function. These arrhythmias interfere with the functioning of the compensatory mechanisms that maintain the endangered appearance per minute, and further threaten to increase the range of ischemic necrosis. Rapid and stable restoration of optimal heart rhythm plays a decisive role in all cases where arithmetic and hemodynamic complications of infarction coexist.

Treatment

It is possible to increase a reduced EF. For 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 and 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.

This is usually a necessary condition for the successful treatment of hemodynamic complications. Elimination of these additional factors plays an important role in the prevention of hemodynamic complications of infarction, as well as in the treatment of already developed complications. Late presentation of hemodynamic complications usually indicates infarction or a mechanical complication. The diagnosis and treatment of acute pulmonary edema complicating recent myocardial infarction are based on the principles outlined in Chap. The improvement achieved with mechanical ventilation should be applied to the rapid-acting drugs digitalis and furosemide.

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.

During medical examinations, many patients quite often hear unclear concepts and diagnoses. When a person has problems with the heart muscle, qualified specialists can calculate the efficiency of cardiac activity. During contraction of the heart muscle, blood is pumped, and the ejection fraction is the amount of blood plasma that enters the vessels. Experts measure this process as a percentage.

Administering morphine in the hope of controlling pulmonary edema in spontaneously breathing patients is contraindicated for the reasons outlined on page 3. Stroke is even more than 50% of the mortality rate in intensive care. There has been no universal consensus regarding the optimal way to treat these patients with pharmacological treatment, although much information has become available on this issue in recent years. The immediate goal of treatment is to increase left ventricular ejection volume to cover metabolic tissue demands.

Most often, in order to measure the amount of blood, doctors take measurements from the left ventricle. Since from it the blood moves through the systemic circulation. If observed reduced level left ventricular ejection fraction in humans, this may contribute to the onset of heart failure.

Therefore, it is recommended to regularly contact a qualified specialist for diagnosis. Several methods can be used to study this process. The simplest of these is ultrasound. It is quite good because the doctor can find out how active and effective the contractions of the heart muscle are. This method is quite simple and convenient, and also does not cause side effects and is not dangerous for the human body.

Patients who have only moderately elevated left ventricular filling pressures often achieve this goal by further increasing filling pressures through rapid intravenous infusion of low-molecular-weight dextran. In terms of balance 4 - Intensive oxygen therapy 49 is the most economical way to increase output; The increase in ejection volume obtained in this way increases the need for myocardial oxygen to a much lesser extent than a similar increase with cardiac contractions.

Suitable only for patients with severe shock syndrome who do not have symptoms of pulmonary edema. In patients with hemodynamic monitoring, the decision to target dextran use can be measured by diastolic blood pressure. In patients eligible for treatment with low molecular weight dextran, we consider this drug to be the first choice in the management of shock that is associated with recent myocardial infarction. At the same time as the dextran infusion, the patient should receive approximately 90 mg trisamine equiv to compensate for the accompanying metabolic acidosis.

The second method of diagnosis is isotope ventriculography. When using this method, you can find out with what efficiency the ejection fraction passes from the right and left ventricles. This option is more expensive, so quite often patients are diagnosed using ultrasound.

In order to draw any conclusions, it is necessary to know what the normal cardiac ejection fraction is in a person. After the diagnosis has been carried out, the results obtained must be compared with the norm, and then the doctor must sum up the results and prescribe the correct and effective course of treatment. If the ejection fraction of the heart muscle is normal and the person does not feel any noticeable disturbances in the functioning of the heart, then everything is normal. The norm for this indicator is 55-70 percent. Even if a person is in a calm state, his left ventricle can throw into the vessels more than half of the blood that is in it.

If a person has a low ejection fraction, a qualified specialist should refer him to the necessary additional tests in order to determine the cause of this process. Quite often, a factor of reduced ejection fraction may suggest the development of various heart diseases, such as heart failure. It can appear due to defects of the heart muscle, as well as coronary artery disease. All of these diseases are quite life-threatening, so they need to be detected as quickly as possible and effective and efficient treatment begun.

If problems and deviations from the normal cardiac ejection fraction are observed, it is imperative to contact a qualified specialist who will conduct a diagnosis. After carrying out diagnostic measures, the doctor must find out the cause of this defect. Then, the doctor must prescribe proper and effective treatment in order to prevent the symptoms and signs of heart disease. The main feature of preventing the disease is constant monitoring by a doctor and compliance with all his recommendations. In order to protect your health, it is necessary to consult a qualified doctor at the first symptoms for diagnosis.