Heart failure: Reduced vs. preserved pumping

 There are actually two distinct forms of heart failure that are characterized by that very measure: the heart’s pumping ability. To distinguish between the two, doctors measure the ejection fraction, which refers to the percentage of blood in the left ventricle (the heart’s main pumping chamber) that is pumped out each time the ventricle contracts. This is most often measured with an ultrasound of the heart (echocardiogram).

For a healthy heart, a normal ejection fraction is 55% to 65%. In about half of people with heart failure, the muscle in the left ventricle becomes thin and weak. The weakened muscles can’t contract very well, causing the ejection fraction to fall below 50%. This is known as heart failure with reduced ejection fraction (HFrEF).

But in other people, the heart muscle stiffens and often thickens, which prevents the ventricles from completely relaxing and filling up with blood. The muscles contract normally and the heart seems to pump a normal proportion of the blood that does enter it. But the heart muscle’s inability to relax completely can still lead to fluid backing up into the lungs, as with HFrEF. This is known as heart failure with preserved ejection fraction (HFpEF).

Men are more likely to have the first type (HFrEF), whereas the other form (HFpEF) is about twice as common in women, particularly older women. The symptoms of both are similar: fatigue, shortness of breath, difficulty being physically active, trouble breathing at night, and swelling in the lower body.

Distinguishing between these two forms of heart failure is crucial because they respond differently to treatment. People with HFrEF can improve their symptoms by sticking to a low-salt diet and limiting how much fluid they drink. They also usually receive several different classes of medications, many of which are also used to treat high blood pressure; see www.health.harvard.edu/heart-meds/heart-failure.

HFpEF, on the other hand, has been much more challenging to treat. Several medications, including those used for HFrEF, have not proved to be useful in HFpEF. However, a number of trials testing novel medications to treat HFpEF are ongoing, so there is a good chance that at least one will pan out. Meanwhile, as many people with HFpEF have high blood pressure, strict control of blood pressure might help.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

1 Corinthians 15:10 But by the grace of God I am what I am, and his grace toward me was not in vain. On the contrary, I worked harder than any of them, though it was not I, but the grace of God that is with me.

John 15:9-11 As the Father has loved me, so have I loved you. Abide in my love. If you keep my commandments, you will abide in my love, just as I have kept my Father’s commandments and abide in his love. These things I have spoken to you, that my joy may be in you, and that your joy may be full.

Philippians 4:4 Rejoice in the Lord always; again I will say, Rejoice.

Isaiah 55:1 “Come, everyone who thirsts, come to the waters; and he who has no money, come, buy and eat! Come, buy wine and milk without money and without price.

Joshua 1:5 No man shall be able to stand before you all the days of your life. Just as I was with Moses, so I will be with you. I will not leave you or forsake you.

Philippians 2:12-13 Therefore, my beloved, as you have always obeyed, so now, not only as in my presence but much more in my absence, work out your own salvation with fear and trembling, for it is God who works in you, both to will and to work for his good pleasure.

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