What are the treatment options for a low left ejection fraction?

Hello,

If by left ventricle is functioning very slow you mean that your echocardiogram shows a low left ventricular ejection fraction (LVEF), this needs evaluation by a cardiologist. The left ventricle is the main pumping chamber of the heart, and LVEF indicates how much blood it pumps out with each heartbeat. A typical LVEF is around 55–70%; an LVEF of 40% or below is generally considered reduced. 

A low LVEF does not automatically mean that surgery is required. The treatment depends on the cause, your exact EF, symptoms, ECG echo findings and other conditions.

What can cause reduced heart function?

Some common causes include

• Previous heart attack or coronary artery disease

• Long-standing high blood pressure

• Heart-valve disease

• Abnormal heart rhythm

• Cardiomyopathy or weakness of the heart muscle

• Certain infections or inflammatory conditions

• Diabetes and other medical conditions

• Some medicines or cancer treatments

Finding and treating the underlying cause is an important part of improving heart function.

What treatment be required?

Depending on the diagnosis, a cardiologist may recommend a combination of medicines and other treatments.

For heart failure with reduced EF, guideline-directed treatment commonly includes medicines from four major groups: ARNI/ACE inhibitor/ARB, evidence-based beta-blockers, mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors. Diuretics may also be prescribed when there is fluid retention.

Do not start, stop or change any heart medicine without your cardiologist's advice.

In selected patients, additional treatment be necessary, such as :

• Treatment of blocked coronary arteries

• Valve treatment

• Treatment for abnormal heart rhythms

• Implantable devices such as ICD or cardiac resynchronization therapy

• Coronary bypass surgery in selected patients with severe coronary disease and reduced EF

These treatments are only appropriate for particular patients after detailed cardiac evaluation. 

Which tests be needed?

Your cardiologist review or order

• Echocardiogram with LVEF

• ECG

• Blood pressure and oxygen level

• Blood tests including kidney function and electrolytes

• Blood sugar and cholesterol

• Cardiac biomarkers when appropriate

• Stress testing or CT coronary angiography

• Coronary angiography if significant blockage is suspected

• Cardiac MRI in selected cases

An echocardiogram is one of the main tests used to assess EF and heart pumping function. 

What precautions should you take?

Until you have been evaluated

• Take prescribed medicines regularly.

• Do not stop heart medicines suddenly.

• Avoid smoking and alcohol.

• Reduce excess salt in your diet.

• Monitor your weight if your doctor recommends it.

• Keep blood pressure and diabetes under control.

• Avoid strenuous exercise until your cardiologist tells you what level of activity is safe.

• Once your condition is stable, supervised cardiac rehabilitation or an appropriate exercise programme may be beneficial. 

When is it an emergency?

Go to the emergency department immediately if you have severe or sudden breathlessness, chest pain/pressure, fainting, severe weakness, blue lips, confusion, or rapidly increasing swelling of the legs/abdomen.

What should you do next?

Please consult a cardiologist, preferably one experienced in heart failure if your EF is significantly reduced. Do not delay evaluation, because treatment can often improve symptoms and, in some patients, improve the ejection fraction.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth