Normal work of the heart is an alternating cyclic alternation of contractions of the muscle layer (myocardium) and complete relaxation, during which the organ rests from the load and prepares for the next beat.
At each systole (contraction), blood is pushed into the aorta, a large circle, and from there it spreads throughout the body. Ejection fraction (EF) is a functional indicator, the ratio of blood leaving the left ventricle to that returning to it.
Special formulas are used for calculations. As a general rule, assessment is carried out in this way. They take the amount of blood ejected into the aorta and take away the end-diastolic volume (EDV, which is returned). The result is multiplied by 100% to obtain a specific value.
All calculations are carried out automatically during echocardiography. The Simpson formula is more accurate and is used in modern devices, and according to Teicholz, it is used in outdated equipment. The difference between the results can reach 10%.
Attention is concentrated on the reduced emission level (less than 45%). The symptoms are varied, because insufficient blood circulation leads to ischemia of all tissues and organs.
Treatment begins in the early stages. The degree of deviation and progression proportionally reduce the likelihood of a favorable outcome.
The main calculation method is presented above. It does not have much practical significance for the patient.
In automatic mode, the level is calculated by instrumental methods using a program preinstalled on the device for echocardiography.
The normal left ventricular ejection fraction (LVEF) in adults is in the range of 50-85%. The first number is considered the lower limit at rest, the second is the maximum after physical activity.
At the same time, cardiac output is an individual indicator. But it should not fall below this level. The critically low EF limit is 45%. Anything less is a direct indication of a pathological process.
To talk about the norm, you need to know a person’s working numbers. The condition can only be assessed through long-term observation of the patient.
Attention:
Cardiac ejection fraction values below 35% indicate a significant, irreversible impairment of the functional activity of the heart. Prognostically unfavorable sign. It is no longer possible to radically help the patient.
Symptoms
The manifestations are different. Left ventricular ejection fraction (LVEF) indicates the force with which blood is pumped into the aorta.
Through the largest artery of the body, liquid connective tissue moves throughout the body, providing structures with nutrients and oxygen.
The defeat of the fraction leads to a proportional decrease in trophism (nutrition). Which means functional disorders. All systems suffer. The heart itself, the kidneys, the liver, the digestive tract as a whole, the brain. The clinical picture does not develop at once.
Heartfelt
It all starts with the cardiac signs themselves:
- Chest pain. Localization may not be clear. Somewhere in the center or slightly to the left. There are known cases of discomfort in the peritoneum and epigastric region.
A characteristic feature of cardiac pain is burning, pressure, distension and impact in the arm, shoulder blade, jaw and teeth.
At first, the unpleasant sensation is minimal and appears periodically. For a few seconds. Progression leads to worsening of the condition. The duration of the episodes increases, and the intensity of the pain also becomes higher.
Relief is possible with Nitroglycerin, but with caution. A critically low ejection fraction (less than 40%) requires precise dosage selection. Possible decrease in contractility, cardiac arrest and death of the patient.
- Dyspnea. Disruption of the natural process. Occurs as a result of insufficient gas exchange. In this case, the pulmonary circulation is already involved.
Restoration of normal activity is possible in the early stages, but then the symptom haunts the person constantly. At first it occurs only after excessive physical exertion. Then at rest.
The manifestation is difficult for the patient to tolerate. Including psychologically, since normal rest becomes impossible. I have to put my pillow higher and wake up frequently.
- Arrhythmia. By type, as a result of artificial stimulation of the natural driver. Then and.
These are already dangerous varieties that can lead to the death of the patient. According to statistics, it is heart rate disorders that cause death in 15-20% of cases among all recorded clinical situations.
- Weakness, drowsiness, decreased ability to work, even perform daily duties. Commonly referred to as asthenia. Leads to constant fatigue, then to mental disorders.
- Violation of the mental plane. Typically, patients with low ejection fraction suffer from depression and anxiety disorders in the medium term.
The addition of angina pectoris causes panic episodes, with a feeling of intense fear. Most of the time the patient is uninitiated, lethargic, and apathetic. The reason must be sought. Classic mental disorders manifest themselves in the same way.
- Blueness of the skin. Pale all over the body. Also mucous membranes. The manifestation is especially clearly visible when examining the gums.
Cerebral
Then we add moments from the brain:
- Headache. It develops suddenly, a clear localization is not determined, except in rare cases. Then the back of the head and parietal region are involved.
The nature of the discomfort is pressing, squeezing, intensifies and pulsates in time with the beat of the heart. Treated with analgesics like Novigan.
The sensation is of vascular origin, therefore it is dangerous for the formation of a stroke if done incorrectly. If it develops, it is recommended to consult a cardiologist, since this is a relatively late manifestation.
- Dizziness. Vertigo. Accompanied by the inability to orientate normally in space. The patient is in a forced position. Usually lying down. Episodes last up to several hours.
- Nausea and vomiting. The previous manifestations complement each other. Even emptying the stomach does not relieve the condition. Because we are talking about a reflex phenomenon. The body is not cleansed, correction does not occur.
- Loss of consciousness. Syncope. Fainting is rare; as the disorder progresses, the ejection fraction becomes more frequent and deeper. This is an unfavorable sign. Talks about the possible imminent occurrence of a stroke. Urgent assistance required.
- Sleep disorders. Like frequent awakenings at night for no apparent reason. Possible vegetative manifestations: increased sweating, tachycardia, anxiety. This continues several times during one episode.
- Visual impairment. The appearance of fog, flies, photopsia (flares).
From other authorities
With a long course of the pathological process with a decrease in the ejection fraction, other manifestations from the organs of the digestive tract and excretory system are added:
- Loss of body weight. Sudden and not related to diets. Occurs in response to long-term disruption of tissue trophism. Differential diagnosis with pathologies of hormonal and tumor profile is required.
- Constipation and diarrhea. Alternating one with the other. Stool instability is associated with unstable intestinal motility and digestive disorders.
- Increased liver size. Secondary or even tertiary hepatitis. The organ protrudes from under the edge of the costal arch, is easily palpated and visible on ultrasound.
Hence the accumulation of fluid in the abdominal cavity (ascites), obstructive jaundice due to the release of bilirubin into the blood, which stains the tissues and sclera of the eyes. - Abdominal pain of unknown etiology.
- Blood admixtures in stool. Fresh. Differential diagnosis with hemorrhoids is required. If black veins are detected - with colorectal cancer.
- Peripheral edema. As a result of a decrease in myocardial contractility. At first, the process covers only the ankles, then rises higher.
Signs are nonspecific. But when assessed as a whole, they indicate cardiac problems.
Causes of reduced EF
Violation of the normal level of ejection fraction develops as a result of cardiac pathologies itself especially often.
There are a lot of options in this case. From hypertension, which was not treated in time, to a recent heart attack (EF falls as a result of the formation of cardiosclerosis), angina pectoris and arrhythmias with a decrease in contractility.
Any disease of a muscle organ can lead to a deviation in the indicator.
Another option is vascular pathologies. Vasculitis, aneurysms, etc. Autoimmune or infectious origin.
Also hormonal diseases with a decrease in the concentration of substances of the pituitary gland, adrenal glands or thyroid gland. Diabetes.
Intoxication with alcohol, drugs, salts of heavy metals and other toxic substances.
The causes of increased EF are mainly due to excessive physical activity. If the output is reduced, this leads to weakened hemodynamics (blood flow). This process is considered dangerous.
As for the opposite phenomenon (EF above normal), it does not play a major clinical role and is rarely stable.
Diagnostics
It is carried out if at least one symptom or warning sign is present.
Reduced ejection fraction is not an independent disease. Such a name cannot be found in the international classifier.
This is an instrumental sign, a functional indicator that is used to ascertain the fact of a decrease in myocardial contractility. What is behind the deviation is the question.
It can be solved using diagnostic methods:
- Oral questioning of the patient. To objectify complaints and identify the complete clinical picture.
- Taking an anamnesis serves the same purpose. Allows you to name the probable cause of the pathological process.
- Blood pressure measurement. Most often it is normal up to a certain point. Falls in proportion to the progression of the disorder.
- Heart rate is also examined. For these purposes, routine calculation of the number of beats per minute, as well as electrocardiography, is performed.
An ECG provides information on the presence of arrhythmias, their nature and degree. It can be carried out during the day using a special Holter monitor.
This is an even more thorough study. Evaluates vital signs over 24 hours, over time.
- Echocardiography. Key technique for identifying functional impairment. The normal cardiac ejection fraction is not a basis for stopping the diagnosis; other pathologies are possible if there are complaints.
The percentage is automatically calculated, and then the doctor makes a conclusion about the normality of the indicator for a particular patient.
The problem is that it’s impossible to immediately say what is within the limits of what is permissible and what is not. It is necessary to observe the person for at least several days, sometimes weeks.
Therefore, it is preferable to manage the patient in a cardiology hospital.
- Blood test for hormones (thyroid, pituitary, adrenal glands), general, biochemical. They can give a lot of information.
- MRI as indicated. Consider the anatomical properties of the heart more carefully. To say whether defects or irreversible changes in the myocardium have formed against the background of a functional disorder.
Additionally, consultation with a neurologist may be required. If problems with the brain are detected, cerebral symptoms are associated.
Routine examination of reflexes allows one to assess the nature of the induced disorder and take action.
Treatment
Therapy is conservative; surgical methods can only help if the cause of the decrease in ejection fraction lies in a heart defect.
First you need to carefully assess the patient's condition and confirm that it is of pathogenic origin. This is indicated by instability of numbers and poor health. There are always symptoms, at least to a minimal extent.
Pathology itself cannot be treated. The root cause needs to be eliminated. There are many of these and not always of cardiac origin.
Detoxification (for poisoning), the use of hormonal replacement drugs (endocrine disorders), relief of septic or autoimmune inflammation (vasculitis, damage to blood vessels and the heart itself) are indicated.
Antihypertensive treatment is prescribed to individuals with persistently high blood pressure levels until the condition is corrected. Of the medications, ACE inhibitors, calcium antagonists and others are most actively used.
To maintain the functioning of the muscular organ itself, the following drugs are prescribed:
- Cardioprotectors. Riboxin or Mildronate.
- Antiarrhythmic. In case of severe heart rate disturbances. Amiodarone, Quinidine, less often others.
- Beta blockers. Anaprilin, Carvedilol. To relieve tachycardia and partially reduce blood pressure.
- Antiplatelet agents. Heparin, Aspirin-Cardio. Prevents the formation of blood clots.
- Nitroglycerin, if the specialist allows it. To improve contractility, restore normal functioning of the organ, eliminate pain in the acute period.
Folk remedies are strictly prohibited. It is recommended to give up smoking, alcohol, and any medications that are not directly prescribed by a specialist, sleep at least 7 hours, walk in the fresh air, and consume less fat.
It is better to clarify questions about restrictions with the doctor, since it is not known what the patient’s initial position was.
Forecast
Mostly favorable if detected early. The probability of a quality life and simply the continuation of biological existence decreases in proportion to the progression of the process.
With proper therapy in the early and middle stages (if the left ventricular ejection fraction is at least 40%), the percentage of deaths is determined at 15%. It happens a little more. In the later stages, 40-60% or more.
Complete correction will never be achieved. The process has already begun, organic disorders in the myocardium are occurring, there is nowhere to put them.
However, it is possible to compensate for the situation, although treatment will most likely continue for many years, if not a lifetime. It's not a big price.
Possible complications
The main thing among others is cardiac arrest as a result of further malnutrition and a decrease in myocardial contractility.
Another clinically common variant is myocardial infarction. As a result of the small volume of nutrients supplied through the coronary arteries to the heart. Leads to death or disability. Further aggravates pathological deviations.
Stroke. Acute weakening of brain nutrition. It is considered the probable end of ischemia of cerebral structures. As soon as disturbances in the functioning of the nervous system appear, such as dizziness, nausea, fainting, you need to run as fast as you can to the doctor to correct the condition and prevent a potentially fatal phenomenon.
Vascular dementia. Possible if the disorder lasts for a long time. Pulmonary edema, cardiac asthma. Also emergency conditions. They pose a great danger to life. Risk of asphyxia.
Most often, this process ends in death or death. But he himself is not the culprit of the terrible consequences. This is just a result, a syndrome. We need to look for the underlying cause, the primary disease.
A drop in ejection fraction is the result of insufficient myocardial contractility. Leads to generalized dysfunction of all organs. Ultimately - to the death of the patient.
Such a sad scenario can be prevented. But you should consult a cardiologist in time to prescribe a course of therapy.
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 VS and FVS, and whether modern medicine can 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, performed in a private medical institution or laboratory, and even by calling 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:
- bradyarrhythmia, tachyarrhythmia;
- heart valve defects;
- end-stage congestive heart failure;
- metabolic disorders in the myocardium;
- occlusion of a shunt or main vessel;
- decreased blood volume;
- accumulation of air in the pleural cavity and compression of the lobes of the lungs;
- accumulation of fluid between the layers of the pericardium;
- oxygen starvation of the myocardium;
- a shift in the body’s acid-base balance towards increasing acidity (decreasing pH);
- sepsis;
- cardiogenic shock.
- Non-cardiac processes:
- massive blood loss;
- extensive burn;
- decreased nervous stimulation of the heart;
- sudden dilatation of veins;
- obstruction of large veins;
- anemia;
- 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 a clinical symptom 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 of muscle tissue, restructuring of small-diameter vessels and alveoli, increasing 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
Despite the fact that low cardiac ejection fraction is a clinical symptom in itself, it has its own characteristic symptoms:
- 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 as part of standard therapy for the disease or condition that causes decreased 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.
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.
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.
On the portal you can download for free:
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 malaise, 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. In addition to drug treatment, surgical intervention is sometimes 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;
- taking medications: 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. the gym is 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 statistics of the 20th century, elderly people most often suffered from cardiovascular diseases. 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 an annual medical examination not only by a cardiologist, but also by other doctors. Remember that only you are responsible for your health!
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.
On the portal you can download for free:
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 malaise, 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. In addition to drug treatment, surgical intervention is sometimes 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;
- taking medications: 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. the gym is 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 statistics of the 20th century, elderly people most often suffered from cardiovascular diseases. 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 an annual medical examination not only by a cardiologist, but also by other doctors. Remember that only you are responsible for your health!
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If you have already undergone an ultrasound examination of the kidneys or, for example, the abdominal organs, then you remember that in order to roughly interpret their results, you most often do not have to contact a doctor - the basic information can be found out before visiting the doctor, by reading the report yourself. The results of cardiac 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 an 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 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.
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.
Reasons for decreased EF
Low values can be caused by pathologies such as:
- Cardiac ischemia. At the same time, blood flow through the coronary arteries decreases.
- History of myocardial infarction. This leads to the replacement of normal heart muscles with scars that do not have the necessary ability to contract.
- Arrhythmia, tachycardia and other ailments that disrupt the rhythm of the body’s main “motor” and conduction.
- 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 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 triggered by long walking, as well as doing 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:
- Drugs are prescribed to improve myocardial contractility. These include cardiac glycosides, after which a noticeable improvement occurs.
- 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.
- Organoprotective agents are prescribed that help protect the heart and blood vessels.
- A decision is made about 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 age of 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.
cardio-life.ru
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 of the 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. Mitral valve closure component.
2. Closure of the tricuspid valve.
3. Pulmonary tone of blood expulsion.
4. Aortic tone of blood expulsion.
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. Aortic valve opening component.
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”.
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