Measuring ejection fraction

Q. After my echocardiogram, my doctor said that my ejection fraction was on the low side and I should get it checked again in a few months. What exactly does the term ejection fraction mean?

A. Ejection fraction is the fraction (expressed as a percentage) of the blood that your heart “ejects” out to the rest of your body each time it contracts. For example, an ejection fraction of 60% means that each time your heart beats, 60% of the blood in the main pumping chamber (the left ventricle) is squeezed out by the heart muscle contracting.

Because we’re used to thinking that 100% is ideal, an ejection fraction of 60% may sound quite low. But healthy hearts pump out only about half to two-thirds of the blood from the left ventricle. So, a normal ejection fraction is about 55% to 70%.

An ejection fraction between around 40% and 50% is considered borderline low. Sometimes, this reflects heart muscle that was weaker but is now recovering. Other times, a slow decline in heart muscle function is to blame. Anything below 40% means the heart is struggling to provide sufficient blood to the body.

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One possible cause of a low ejection fraction is damage from a previous heart attack. Another is cardiomyopathy, a disease of the heart muscle that has many different causes, including viral infections and genetic disorders. A leaky valve or narrowed heart valve or chronic, untreated high blood pressure can also decrease ejection fraction. An abnormally fast heart rate for a long period of time, such as from uncontrolled atrial fibrillation, can make the heart appear weak. Sometimes heart muscle function improves once the underlying cause is treated, but not always.

An echocardiogram (heart ultrasound) is the most common way to measure ejection fraction, but other tests can also provide the measurement. One that is often done to investigate chest pain is a nuclear stress test, in which a radioactive substance is injected into a vein and a special camera detects the radiation. The resulting images reveal blood flow in the heart muscle. Another is a cardiac catheterization, in which a cardiologist snakes a thin tube (catheter) though an artery in the arm or leg up to the heart. The primary purpose is to look for blocked arteries. But with an additional step, an extra picture can reveal how well the left ventricle is pumping. Other imaging techniques, including MRI or CT, can also measure ejection fraction. Be aware that if you have more than one of these tests, the ejection fraction measurements may differ slightly. And remember that the ejection fraction is just one number. Many other factors help determine how well the heart is working.

— Deepak L. Bhatt, M.D., M.P.H.
Editor in Chief, Harvard Heart Letter

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

2 Corinthians 13:9 For we rejoice when we ourselves are weak but you are strong; this we also pray for, that you be made complete.

Colossians 1:28 We proclaim Him, admonishing every man and teaching every man with all wisdom, so that we may present every man complete in Christ.

Colossians 4:12 Epaphras, who is one of your number, a bondslave of Jesus Christ, sends you his greetings, always laboring earnestly for you in his prayers, that you may stand perfect and fully assured in all the will of God.

2 Corinthians 10:15-16 not boasting beyond our measure, that is, in other men’s labors, but with the hope that as your faith grows, we will be, within our sphere, enlarged even more by you, so as to preach the gospel even to the regions beyond you, and not to boast in what has been accomplished in the sphere of another.

2 Thessalonians 1:3 We ought always to give thanks to God for you, brethren, as is only fitting, because your faith is greatly enlarged, and the love of each one of you toward one another grows ever greater;

2 Peter 3:18 but grow in the grace and knowledge of our Lord and Savior Jesus Christ To Him be the glory, both now and to the day of eternity. Amen.

Ephesians 1:17-18 that the God of our Lord Jesus Christ, the Father of glory, may give to you a spirit of wisdom and of revelation in the knowledge of Him. I pray that the eyes of your heart may be enlightened, so that you will know what is the hope of His calling, what are the riches of the glory of His inheritance in the saints,

Ephesians 3:16-19 that He would grant you, according to the riches of His glory, to be strengthened with power through His Spirit in the inner man, so that Christ may dwell in your hearts through faith; and that you, being rooted and grounded in love, may be able to comprehend with all the saints what is the breadth and length and height and depth, read more

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