Drug treatment of sleep with low left ventricular ejection fraction. Norms of left ventricular ejection fraction of the heart, causes of low and increased values, treatment methods and prognosis FV 69 cardiac ultrasound

An important diagnostic method

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

2 Ejection fraction

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

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

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

3 Dimensions of heart chambers

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

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

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

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

Right ventricle. Basal diameter - ≤ 41 mm;
End-diastolic volume (EDV) RV/APT (men) ≤ 87 ml/m2, women ≤ 74 ml/m2;
End systolic volume (ESV) of the RV/PPT (men) - ≤ 44 ml/m2, women - 36 ml/m2;
The thickness of the pancreas wall is ≤ 5 mm.

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

4 Valves

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

1. Aortic valve. Area - 2.5-4.5 cm2; average pressure gradient
2. Mitral valve (MV). Area - 4-6 cm2, average pressure gradient

5 Vessels

Pulmonary artery. The diameter of the pulmonary artery (PA) is ≤ 21 mm, the acceleration time of the PA is ≥110 ms. A decrease in the lumen of the vessel indicates stenosis or pathological narrowing. Systolic pressure ≤ 30 mm Hg, mean pressure ≤ 20-25 mm Hg; An increase in pressure in the pulmonary artery that exceeds acceptable limits indicates the presence of pulmonary hypertension.

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

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

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

FVS is an indicator that determines the amount ejected by the left ventricle into the aorta during contraction of the organ. This indicator is calculated using a special formula.

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

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

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

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

Video about what cardiac ejection fraction is, normal and pathological abnormalities.

If a person is at physiological rest, then normal value EF is a figure of 50-75 percent. Significant physical activity in people leads to an increase in the rate to 80-85 percent. No further increase is observed. This is explained by the fact that the myocardium cannot eject all the blood from the ventricle, as this causes cardiac arrest.

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

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

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

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

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

Simple online calculator, designed to calculate the ejection fraction of the heart (left ventricle). Ejection fraction is an indicator that determines the efficiency of the muscles of the heart organ at the moment of impact. The left ventricular ejection fraction is calculated to analyze the state of the myocardium and its contractility, and determine the prognosis for patients with heart failure. EF is measured as a percentage of the stroke volume of blood to the volume of blood in the left ventricle at the time of its relaxation (diastole). Stroke volume is the volume of blood ejected into the aorta, that is, the amount of blood pumped by the heart in one minute. And when the ventricle is relaxed, it contains blood from the left atrium (end-diastolic volume - EDV).

Left Ventricular Ejection Fraction Calculator

Stroke volume

End diastolic volume

Ejection fraction

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Formula:

FV = (UO/KDO)*100,

• FV– Ejection fraction
• UO– Stroke volume
• KDO— End-diastolic volume

Example:

The patient's stroke volume is 120 ml, and the end-diastolic volume is 150 ml; let's calculate the ejection fraction.

Solution:

FV= (UO/KDO)*100
= (120/150)*100
= 0,8*100
=80%

Normal ejection fraction differs between different people, but on average this figure is normally 50-60%. It is this part of the blood that can adequately provide blood supply to the organs and systems of the body.

An outlier value of 35-45% indicates a diagnosis of “advanced form of failure.” Lower values ​​of the indicator are life-threatening.

Some people experience an increase in fraction values ​​(80% or higher). This means that the heart contracts with great force, so it is expelled into the aorta more blood. Most often we are talking about healthy people without any cardiac pathology or athletes with a trained heart.

Ejection fraction is also measured using echocardiograms, CT scans, MRI, and cardiac catheterization.

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. Ultrasound examination of the heart muscle is often performed. 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 circulatory system 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, increased 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 see a 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 in the chest, interruptions in heart function, rapid heartbeat, shortness of breath when physical activity, dizziness, fainting, swelling in the legs, fatigue, decreased performance, weakness. The first tests are usually an electrocardiogram and biochemical analysis blood. 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 ​​the fraction cardiac output.

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 big circle blood circulation It is left ventricular failure that leads to the development clinical picture heart failure most often. 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. The cardiologist may prescribe conservative treatment 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 surgical treatment decreased 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.

Cardiac ejection fraction (EF) is an indicator by which the quantitative volume of blood ejected into the aorta is recorded during the conduction of an electrical impulse in the left ventricle.

This indicator is calculated by the ratio of the blood that enters the largest vessel to the amount of blood that fills the left ventricle when its tissues weaken.

This value, simply calculated, stores a lot of information regarding the possibility of contractions of the heart muscle. Determining EF affects the prescribed medications for the heart, and EF is also used to predict life for people with heart failure.

The closer the EF values ​​are to normal, the better the heart beats. If the ejection fraction deviates below normal indicators, this indicates that the heart is unable to contract at a normal rate, resulting in poor circulation.

In such a situation, you need to urgently consult a doctor for qualified help.

How is the PV calculated?

Calculating this fraction is not difficult, but it contains enough large number information about the heart muscle and its ability to contract normally.

In many cases, Doppler ultrasound of the heart is used to determine ejection fraction.

The fraction indicator is calculated using the Teicholz formula or the Simpson formula. All calculations occur using a program that automatically produces a result depending on the amount of blood in the unstressed left ventricle, which is pushed into the aorta.

The main differences between the above formulas are:

• The Teicholtz formula determines the amount of blood ejected from the ventricle using M-modal ultrasound examination. This formula patented by Teicholz in nineteen seventy-six.
• A small part of the ventricle at its base is examined; the length is not taken into account. False results obtained by the formula can occur during ischemic attacks, when contractions are disrupted in certain areas of the heart muscle.
• The program takes into account information about the volume in the relaxed and contracted left ventricle, producing the result automatically. This method is used on equipment that is currently outdated;
• According to the Simpson formula, a quantitative two-dimensional ultrasound examination of the heart is performed, with the help of which more accurate results are obtained. Simpson's algorithm was patented by him in nineteen eighty-nine. The identical name for this algorithm is the disk method. At this study ejection fraction, all important areas of the heart muscle are examined.

Fact! The study results of the same patient, according to different formulas, can fluctuate with a difference of ten percent.

What features does FV have?

The main features inherent in the ejection fraction are the following:

Norms

Individual indicators of ejection fraction are considered normal for a person, since for different age categories of people, its levels can vary. Also, the ejection fraction norm levels depend on the calculation formula and the equipment on which the analysis is carried out.

Average generally accepted normal value:

1. For the Simpson formula, it is from fifty to sixty percent, with an extreme lower limit of forty-five percent;
2. According to the Teicholz formula, the lowest limit is fifty-five percent. The lower bar indicator determines what percentage of blood needs to be squeezed into the aorta in order for it to reach the organs. required quantity oxygen.
3. In the case of heart failure, rates range from thirty-five to forty percent. In this condition, medication maintenance of the body or surgical intervention is necessary.
4. At rates below 35 percent, rapid complications and death may occur.

IN childhood ejection fraction values ​​are slightly increased. In newborns it is no less than sixty percent and can reach eighty. As the body develops and the child grows, the level of ejection fraction returns to normal.

With deviations, in most cases, there is a decline in the ejection fraction rather than an increase. Various pathological conditions affect the decrease in EF levels.

When the ejection fraction is below normal, it indicates that the myocardium cannot contract at a normal rate. It leads to impaired blood circulation in the body and oxygen starvation of organs. Initially, the brain suffers from hypoxia.

In some cases, the study results show ejection fraction limits above 60 percent. In many cases, they do not exceed 80 percent, since a healthy left ventricle cannot throw more blood into the aorta due to its structural features.

Also, with pathological enlargement of the heart muscle, an increased ejection fraction may indicate that the myocardium cannot restore progressive heart failure and is trying to eject into the aorta greatest number blood.

As heart failure progresses, the ejection fraction decreases. That is why it is important to monitor deviations in EF in one direction or another, and immediately contact the hospital for examination.

Why is the decline happening?

The initial stages of progression of heart disease do not affect the ejection fraction. This happens because the heart muscle tries to adapt to the changes (the layer of the myocardium increases, its contractions become more frequent, and the small vessels of the heart are rebuilt). Find out what cardiac muscle is.

As the disease progresses, the muscle wears out more and more, which leads to deviations in functional abilities that lead to structural damage. All this disrupts the amount of blood ejected by the left ventricle into the aorta, causing disruptions in blood circulation.

Such deviations are provoked by everything that negatively affects the heart muscle:

Symptoms of deviation

Impairment of physical and labor activity are the main consequences of violation of the normal boundaries of the cardiac ejection fraction. There is a significant deterioration in the condition, in which everyday activities become difficult to perform.

In most cases, the following symptoms appear in case of circulatory disorders:

If one of the above symptoms is detected, you must immediately go to the hospital for examination.

How are low scores treated?

Since a decrease in ejection fraction is not a separate disease, but is only provoked by initial diseases, a qualified doctor should send the patient for additional hardware examinations that will help determine the root cause of the decrease in ejection fraction.

Depending on the cause that provoked the decrease in ejection fraction, treatment may be:

1. Medication;
2. Surgical.

For ischemic attacks, it is necessary to take nitroglycerin to normalize EF, and for hypertension, antihypertensive drugs, etc.

It is important to understand that with a decrease in EF, heart failure progresses, which requires compliance with all doctor’s recommendations.

Drugs

The main drugs that affect the increase in ejection fraction are listed in the table below.

Additional agents that can improve ejection fraction in some cases include the following.

There are also groups of drugs that are auxiliary and are prescribed in

in certain situations, in combination with the main therapy.

Surgical intervention

In case of deviation, ejection fractions can be applied surgical interventions. View surgery depends on individual indicators and pathological conditions patient.

In most cases, the following surgical methods are used:

• Implantation of a defibrillator or cardiac pacemaker. Through open heart surgery, a device is installed that, in case of heart rhythm disturbances, restores normal blood circulation by electrically acting on the heart;

• Impact on different rhythms of the ventricles and atria. They achieve a slowdown in ventricular contractions using artificial heart block. This restores the necessary flow of blood entering the ventricles.

What will help improve the condition, in addition to the main course of treatment?

For complex treatment The following recommendations must be adhered to. Only by observing them and the correctly prescribed method of treatment.

Long-term normalization of ejection fraction can be achieved:

• Normalize your daily routine by setting aside time for good sleep(at least 8 hours);
• Moderate physical exercise. Necessary for the speedy restoration of myocardium damaged by the underlying causes. It is important not to overdo it so as not to damage the heart muscle;
• It is recommended to engage in light sports (physical education, swimming, aerobics, etc.), and also devote at least one hour a day to walking;
• Avoid strenuous physical activity;
• Eat right. And also consume more food rich in iron;
• Massage is recommended to improve blood circulation and relieve swelling;
• Avoid stressful situations. Strong emotional stress (both positive and negative), constant stress, depression - all this affects the deformation of the myocardium due to its overstrain;
• Maintain normal water balance. Drink at least one and a half liters of clean drinking water per day;
• Reduce salt intake;
• Get rid of bad habits. Toxins supplied with alcoholic beverages and cigarettes irritate the myocardium.

You can take blood thinners:

• Willow bark - prevents clots from forming, thinning the blood;
• Red clover. Concentrates salicylic and coumaric acids. Regular use of this decoction reduces the thickness of the blood;
• Meadowsweet. Contains the same acids as clover, plus ascorbic acid. Has a positive effect on the body, strengthening blood vessels, fighting rheumatism, and killing bacteria;
• Sweet clover yellow. Contains a high concentration of coumarins, which slow down clotting;
• Hawthorn is a fairly common plant. Its leaves strengthen blood vessels, have a positive effect on the heart, and also thin the blood. For medical purposes it is used in the form alcohol tincture or extract;
• Rakita. Bush plant, with a high concentration of flavonoids and salicylates. Prevents inflammation and tones, inhibits clotting processes and strengthens blood vessels. For treatment purposes, the bark is used;
• Ginko Biloba. A powerful antioxidant, dilates blood vessels, preventing blood clots from forming. Positively affects blood flow in the brain, improving memory and attention.

Also sometimes they use means to calm the body, since under emotional and nervous influence complications of heart disease worsen.

These include:

There are also the following methods to calm the nervous system:

• Garlic with milk. To prepare, you need to grate a clove of garlic into milk and consume half an hour before breakfast;
• Honey with water. Dissolve 50 grams of honey in half a liter of water and drink in 4 doses throughout the day.

Attention! Use of any means traditional medicine requires prior consultation with the attending physician. Taking them on your own can lead to complications.

Prevention

In order to maintain a healthy body, you should adhere to the following recommendations:

• If available overweight, it is recommended to reset it;
• Avoid stressful situations and nervous tension;
• Stick to a daily routine, proper rest and sleep;
• Monitor blood pressure readings;
• Eat less animal fats and more plant fats;
• Eat a balanced diet;
• Get rid of a sedentary lifestyle, play sports;
• Quit smoking and drinking alcohol.

What is the prognosis for deviations in EF?

If the ejection fraction drops to forty percent, then the risk of death from sudden cardiac arrest is up to fifteen percent. If it drops to 35 percent, the risk is up to 25 percent. If indicators fall below these levels, then the risk increases proportionally.

It is not possible to completely cure ejection fraction abnormalities, but early therapy will help prolong life with normal functioning.

If any symptoms or already diagnosed diseases are detected, you should be constantly monitored by a cardiologist and undergo regular tests. This is done to prevent the progression of complications.

DO NOT self-medicate and be healthy!