Low ejection fraction. Exercise for the treatment of heart failure. Risk factors, symptoms. What is normal ejection fraction

Diseases of the cardiovascular system have been and remain the primary cause of death in many countries around the world. Every year, 17.5 million people die from cardiac pathologies. In this article, we will consider what the EF of the heart demonstrates, what are the norms of this indicator, how to calculate it, in which cases you should not worry, and in which you should consult a doctor.

The ejection fraction of the heart (EF) is a reflection of the quality of its work. In other words, this is a criterion that reflects the volume of blood pushed out by the left ventricle at the time of its contraction into the aortic lumen. This volume must meet certain standards: it should not be too much or too little. For the first time with this term, patients meet at the appointment with a cardiologist, namely during the passage of an ultrasound examination or ECG.

The efficiency of the heart is calculated as a percentage. An example will be indicative: if the left and right ventricles contained 100 ml of blood before the contraction, and only 30 ml remained after the contraction, then the EF will be equal to 70%. The correct measurement of this parameter is carried out in the left ventricle. If the doctor receives a lower than normal EF measurement, there is a risk of the patient having heart failure, so this ratio should be monitored.

How to calculate the minimum and maximum rate? In medicine, experts use two possible methods: the Teicholtz formula and the Simpson formula. The data obtained by these two calculations may differ by approximately 10%. The calculation is made by a special program that automatically calculates the result, due to the final indicators of the systolic and diastolic volume of the left ventricle.

Carrying out diagnostics on modernized ultrasound machines, specialists are more willing to resort to the Simpson method, since it is more reliable. However, in less modern clinics and hospitals, the Teicholz method is more often used, in the absence of new ultrasound machines.

The PV index should fluctuate within 50-60%. The minimum rate for Teicholtz and Simpson also differs by 10% - the rate for the first is 45%, for the latter - 55%.

established norm

Decreed PV norm is 55-70%. Even in a state of complete rest, the left ventricle must expel more than 50% of the blood in the cavity. During sports, this criterion grows: with an increase in heart rate, the norm is kept in the region of 80-85%. The level of EF cannot rise above, this is practically unrealistic - the myocardium cannot push all the blood out of the ventricle. This would lead to cardiac arrest. In medicine, a decrease in the norm of EF is more often observed. At rates below 45%, the patient has heart failure.

Acceptable Data Indicators for Children

In the younger age category, the limits of the norm may be slightly higher than in adults. In particular, in newborns up to adolescence, the EF is at least 60%, on average - 60-80%. In the process of growth, this criterion takes on normal boundaries. However, if the child has an increase in this parameter, and it does not decrease with age, you should consult a doctor for further diagnosis of a possible disease.

Below is a table that shows what sizes of heart vessels and what EF index are normal.

Adult metrics

Adequate EF in adults does not depend on gender, but depends on age. So, for older people, its decrease is characteristic. A decrease in the rate to 40% indicates a violation of the contractile function of the myocardium, and a drop in the rate to 35% entails serious consequences that pose a threat to life.

Graph - The norm of the ejection fraction of the heart in adults

Factors of worsening EF indicators

Once a normal VWF level has been determined, the question arises as to why some patients suffer from low levels. Most often, the following pathologies are to blame:

• any form of angina pectoris, myocardial infarction (the appearance of scars on muscle tissue, due to which its contractile function is impaired), cardiac ischemia, and more;
• cardiomyopathy - hyperplasia of the heart muscle, which occurs due to a malfunction of the hormonal system;
• deviations in the work of the endocrine system, specifically hyperthyroidism and hypothyroidism, diabetes mellitus and problems with the adrenal glands;
• arrhythmia (violation of the heart rhythm);
• infectious diseases of the heart tissue, such as myocarditis;
• the negative impact of alcohol, nicotine, caffeine and other intoxicants;
• taking drugs;
• congenital diseases, such as heart disease;
• kidney disease, kidney failure;
• insufficient filling of the heart with blood, or, conversely, excessive.

Symptoms of a decrease in this index

Quite often, patients do not suspect that they have any diseases and learn about them randomly. The following conditions may be the reason for worries and a trip to a specialist:

• shortness of breath, both during sports and during complete rest. A particularly indicative symptom is heavy breathing in the supine position, as well as at night during sleep;
• malaise, dizziness, frequent fainting;
• swelling of the limbs and facial part;
• cramps in the region of the sternum and heart;
• discomfort in the right side of the abdominal cavity (due to fluid retention);
• sudden weight loss;
• cyanosis.

In a healthy person, the amount of blood flowing from the left ventricle into the aortic lumen should not be less than half of the total blood volume. If the amount of blood expelled falls, then the patient is likely to develop heart failure.

All of the above signs a qualified specialist should know and notice in a patient. The doctor will direct the patient to undergo all sorts of diagnostic procedures in order to understand if he has abnormalities: Only after that he prescribes the proper treatment.

Treatment for reduced EF

If the indicator drops to 45% or lower, then this is the first sign of a progressive disease of the cardiovascular system. This indicates changes in the tissues of the middle muscle layer of the heart, that is, the myocardium. After identifying the cause of the decrease in the observed parameter, the doctor prescribes the appropriate therapy. Consider all possible ways to increase PV:

conservative technique

If there is no urgent need for surgical intervention, the doctor prescribes medications to the patient:

1. Diuretics are prescribed to reduce the volume of circulating blood, as well as to relieve swelling of the extremities. Among them are Hydrochlorothiazide, Triamterene, Spironolactone, diuretics based on indapamide, furosemide and torasemide. But do not forget that some diuretics flush out potassium from the body, which contributes to the normal functioning of the heart.
2. ACE inhibitors, to protect the walls of the heart and blood vessels - zofenopril (, Alkadil), (Epsitron, Irumed, Lizacard), (, Sinopril), (, Enarenal).
3. Beta-blockers - Betoptik, Biprol, Metoprolol, Egilok and others.

It is strictly forbidden to start using the above drugs on your own, they can only be prescribed by a qualified cardiologist who has studied the picture of the disease in detail. Self-medication in this case can lead to serious complications, deterioration of the general condition and even death.

Surgical intervention

Unfortunately, in some cases of decreased EF, a conservative technique is ineffective and ineffective. Most likely, the doctor will insist on surgical intervention and may prescribe the following surgical procedures:

• installation of a pacemaker;
• heart valve replacement - a natural valve is replaced with a special prosthesis (artificial valve);
• the formation of an artificial path for the movement of blood (in other words, shunting);
• resynchronization therapy;
• heart transplant.

Traditional medicine methods

The patient must be aware that home treatment and traditional medicine are ineffective in this case. But still, there are several options to eliminate symptoms and keep the heart working:

1. To eliminate swelling of the limbs, it is recommended to take a decoction of flax. To make homemade medicine, you need to take two tablespoons of flax seeds and pour a glass of boiling water, after which you should bring the drug to a boil and cook over low heat for 20 minutes. Drink a decoction every 2 hours, half a cup. There are other folk ways to relieve swelling, namely, to do special exercises that promote lymphatic outflow.
2. To improve the functioning of the cardiovascular system, decoctions of cranberries, raspberries, and hawthorn are shown. The latter is the most effective because it helps to normalize the heart rate and can reduce the risk of heart failure and other heart problems. 6 tablespoons of medicinal raw materials are poured with boiling water in a volume of 1.5 liters. The decoction should be left for a day to infuse. After decanting, the medicinal drink is placed in the refrigerator. It is recommended to take three times a day 30 minutes before meals.
3. Also, it will not be superfluous to take sedative herbs. These include sage, mint, chamomile, calendula, pine buds. Decoctions of these herbs should be drunk daily.

Prevention

As mentioned earlier, the main factor in the deterioration of EF indicators are various pathologies of the heart, therefore, preventive activities are aimed at avoiding their occurrence. The first thing to start with is maintaining a healthy lifestyle: excluding fatty and unhealthy foods from your daily diet, the presence of sports in life. Every day you need to spend at least 40 minutes in the fresh air, preferably in nature. Doctors strictly recommend giving up bad habits, namely, eliminating smoking and reducing alcohol consumption to a minimum. You should also limit your caffeine intake. If you follow the above recommendations, the risk of reducing the EF is minimized. In addition, you should visit a cardiologist from time to time and do a cardiogram.

Every patient, and especially older people, should remember the following:

1. With a decrease in EF to 40-45%, the threat of death fluctuates between 10-15%.
2. In addition, EF in the range of 35-40% increases the likelihood of death to 20-25%.
3. The lower the EF falls, the less likely it is to count on a positive outcome of treatment.

EF is a criterion reflecting the functional abilities of the heart. As a rule, cardiac diseases provoke a decrease in the rate of blood ejection. Such conditions are subject to medical and surgical correction. Since it is impossible to completely cope with the problem, deviation prevention is important.

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

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

This value, simply calculated, stores a lot of information regarding the possibility of contractions of the heart muscle. The definition of EF affects the prescribed medicines for the heart, and the prediction of life for people with heart failure is also made according to EF.

The closer the EF values ​​​​to the norm, the better the heartbeat occurs. If the ejection fraction deviates below normal, this indicates that the heart is not able to contract at a normal rate, which leads to impaired blood circulation.

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

How is PV calculated?

The calculation of this fraction is not difficult, but it contains a fairly large amount of information about the heart muscle and its ability to normal contractions.

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

The fraction index is calculated using the Teicholtz formula, or by the Simpson formula. All calculations are made with the help of a program that automatically gives the result, depending on the amount of blood in the unstressed left ventricle, pushed into the aorta.

The main differences between the above formulas are:

• According to the Teicholtz formula, the amount of blood ejected from the ventricle is determined using an M-modal ultrasound examination. This formula was patented by Teicholtz in 1976.
• A small part of the ventricle at its base is examined, the length is not taken into account. False results obtained by the formula may occur during ischemic attacks, when contractions are impaired in certain areas of the heart muscle.
• The program takes into account information about the volume in the relaxed and contracted left ventricle, giving the result automatically. This method is used on equipment that is currently obsolete;
• 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 1989. The identical name for this algorithm is the disk method. In this study of ejection fraction, all important areas of the heart muscle are examined.

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

What are the features of the FV?

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

Norms

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

Average generally accepted normal value:

1. For Simpson's formula is fifty to sixty percent, with the lowest bar being forty-five percent;
2. According to the Teicholtz formula, the lowest bar is fifty-five percent. The indicator of the lower bar determines what exactly such a percentage of blood needs to be squeezed into the aorta in order for the right amount of oxygen to reach the organs.
3. In case of heart failure, the indicators range from thirty-five to forty percent. In this condition, medical maintenance of the body, or surgical intervention is necessary.
4. At rates below 35 percent, early burdens can occur, as well as death.

In childhood, the ejection fraction indicators 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 its growth. Various pathological conditions affect the decrease in EF levels.

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

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

Also, with a pathological increase in the heart muscle, an increased ejection fraction may indicate that the myocardium cannot recover from progressive heart failure and is trying to eject the largest amount of blood into the aorta.

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

Why is there a decline?

The starting stages of the progression of heart disease do not affect the ejection fraction. This happens because the heart muscle is trying to adapt to changes (the layer of the myocardium increases, its contractions become more frequent, and the small vessels of the heart are rebuilt). Familiarize yourself with what a heart muscle is.

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

Such deviations provoke everything that negatively affects the heart muscle:

Deviation symptoms

Violation of physical and labor activity are the main consequences of violation of the normal boundaries of the ejection fraction of the heart. There is a significant deterioration in the state in which daily activities become difficult to perform.

In most cases, with circulatory disorders, the following symptoms appear:

If one of the above symptoms is detected, it is urgent to go to the hospital for examination.

How are low scores treated?

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

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

1. medication;
2. Surgical.

With 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.

Preparations

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

Additional tools that can improve the ejection fraction in individual cases include the following.

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

individual situations, in combination with the main therapy.

Surgical intervention

When the ejection fraction is deviated, surgical interventions can be used. The type of surgical operation depends on the individual parameters and pathological conditions of the patient.

In most cases, the following operational methods are used:

• Implantation of a defibrillator or 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. Achieve a slowdown in ventricular contractions, with the help of artificial heart block. This restores the necessary flows of blood entering the ventricles.

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

For complex treatment it is necessary to adhere to the following recommendations. Only by observing them, and correctly prescribed method of treatment.

Long-term ejection fraction normalization can be achieved:

• Normalize the daily routine, allocating time for a good sleep (at least 8 hours);
• Moderate exercise. Necessary for the speedy recovery of the 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 go in for non-heavy sports (physical education, swimming, aerobics, etc.), as well as allocate at least one hour a day for walking;
• Avoid strong physical exertion;
• Eat properly. 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 alcohol and cigarettes irritate the myocardium.

You can take blood thinners:

• Willow bark - prevents the formation of clots, thinning the blood;
• Meadow clover. Concentrates salicylic and coumaric acids. Regular intake of such a decoction reduces the density of the blood;
• meadowsweet. Contains the same acids as clover, plus ascorbic acid. It has a positive effect on the body, strengthening blood vessels, fighting rheumatism, and killing bacteria;
• Sweet clover is 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 as an alcohol tincture or extract;
• Rakita. Bush plant, with high concentration of flavonoids and salicylates. Prevents inflammation and tones, inhibits coagulation processes and strengthens blood vessels. For the purpose of treatment, the bark is used;
• Ginko Biloba. The most powerful antioxidant, dilates blood vessels, preventing blood clots from forming. It has a positive effect on blood flow in the brain, improving memory and attention.

Also, sometimes they use means to calm the body, since under the emotional and nervous influence, the aggravation of heart diseases is aggravated.

These include:

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

• Garlic with milk. For cooking, 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! The use of any traditional medicine requires prior consultation with the attending physician. Self-administration can lead to complications.

Prevention

In order to maintain a healthy state of the body, the following recommendations should be followed:

• If there is excess weight, it is recommended to lose it;
• Avoid stressful situations and nervous tension;
• Adhere to the regime of the day, proper rest and sleep;
• Monitor blood pressure;
• Eat less animal fats, and more vegetable;
• Eat in a balanced way;
• Get rid of a sedentary lifestyle, play sports;
• Stop smoking and drinking alcohol.

What is the forecast for EF deviations?

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

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

In case of detection of any symptoms, or already diagnosed diseases, it is necessary to constantly monitor the cardiologist and regularly take tests. This is done to prevent the progression of complications.

DO NOT self-medicate and be healthy!

Reduced values impact indicators(e.g., volume, work, strength, and their indices adjusted for body surface area) are often associated with reduced myocardial contractility, but since these parameters are highly dependent on pre-afterload, these two variables also need to be determined. The dependence of SV on preload was described more than 100 years ago by Otto Frank and E.N. Starling (since then it has been called the Frank-Starling mechanism). Based on the relationship between preload and SV or systolic work, a ventricular function curve can be constructed using values ​​of systolic work at different levels of preload, which can be expressed as ventricular EDV, end-diastolic wall tension, or end-diastolic wall tension.
On the preload may be affected by volume loading (raising legs, infusing large volumes of fluid) or reducing it (occlusion with a balloon catheter of the vena cava).

LV afterload can be calculated from mean or end systolic arterial or ventricular pressure, or, more accurately, by calculating mean systolic, peak systolic, and end systolic wall stress. The most reliable method for determining LV contractility is to determine the ratio of pressure to volume at the end of systole (KVD / KSO; maximum elasticity), because. this indicator is almost independent of pre- and afterload.

Slope of the given line ratio indicates LV contractility. The use of ventricular function curves in assessment is limited by the technical difficulties of making measurements on patients, changes that occur over the time it takes to make measurements, and varying interpretations, as interpretation depends on gender, patient age, and afterload. Changes in RV DN can affect the position of the interventricular septum (IVS) and change LV diastolic pressure, thus changing the position of the ventricular function curve.

Ejection fraction of the left ventricle

There are several indices global systolic function and LV contractility. Each index to some extent depends on pre- and afterload and may vary depending on the volume of the ventricle and myocardial mass. An important feature of their use in clinical practice is ease of use.

Ejection fraction is the ratio of MA to BWW. In most cases, it is calculated by the formula: EF \u003d (EDV - ESV) / ​​EFV x 100 (%), where EF is the ejection fraction, EDV is the end diastolic volume, ESD is the end systolic volume.

Normal value of LV EF- 55-75% with cineangiography and echocardiography, but may be lower when determined by radionuclide angiography (45-65%). There are no tender differences. However, with age, there is a tendency to decrease in EF. A sharp increase in afterload, as with a sharp increase in pressure load, leads to a decrease in EF by up to 45-50% in healthy people. However, a decrease in LVEF< 45% свидетельствует об ограниченной функции миокарда, независимо от условий нагрузки.

Widespread use of PV in clinical practice is the result of a number of factors: ease of calculation, reproducibility with different imaging modalities, and extensive literature supporting its clinical utility. This indicator has an important prognostic value (both short-term and long-term) in patients with various CVDs. Nevertheless, it has its limitations, since it depends not only on myocardial contractility, but also on pre-afterload, as well as on heart rate and contraction synchrony. This parameter is also global, and regional differences in contractility appear to be averaged.

Cardiac output is one of the most important characteristics that allows you to control the state of the cardiovascular system. This concept refers to the volume of blood pumped by the heart into the vessels over a certain interval, measured by a time interval or contractile movements of the heart muscle.

The volume of blood pushed out by the heart into the vascular system is defined as minute (IOC) and systolic, also known as shock (SV).

To determine the IOC, the amount of blood that has passed through one of the atria in 1 minute is counted. The characteristic is measured in liters or milliliters. Taking into account the individuality of the human body, as well as the difference in physical data, experts introduced the concept of cardiac index (CI). This value is calculated by the ratio of the IOC to the total body surface area, which is measured in square meters. The SI unit is l/min. m².

When transporting oxygen through a closed system, blood circulation plays the role of a kind of limiter. The highest indicator of the minute volume of blood circulation obtained during the maximum muscle tension, when compared with the indicator recorded under normal conditions, makes it possible to determine the functional reserve of the cardiovascular system and, specifically, the heart by hemodynamics.

If a person is healthy, the hemodynamic reserve varies from 300 to 400%. The figures inform that without fear for the state of the body, a three-fold - four-fold increase in the IOC, which is observed at rest, is possible. In people who systematically go in for sports and are well developed physically, this figure can exceed 700%.

When the body is in a horizontal position and any physical activity is excluded, the IOC is in the range from 4 to 5.5 (6) l / min. Normal SI under the same conditions does not leave the limits of 2–4 l/min. m².

The relationship of the IOC with organs at rest

The amount of blood filling the circulatory system of a normal person is 5-6 liters. One minute is enough to complete a complete circuit. With heavy physical work, increased sports loads, the IOC of an ordinary person rises to 30 l / min, and for professional athletes even more - up to 40.

In addition to the physical condition, the indicators of the IOC largely depend on:

• systolic blood volume;
• heart rate;
• functionality and condition of the venous system through which blood returns to the heart.

Systolic blood volume

Systolic blood volume refers to the amount of blood pushed out by the ventricles into the great vessels during one heartbeat. Based on this indicator, a conclusion is made about the strength and efficiency of the heart muscle. In addition to systolic, this characteristic is often referred to as stroke volume or OS.

The systolic volume of blood circulation is calculated as the amount of blood pushed out by the heart into the vessels during one contraction.

At rest and in the absence of physical exertion, 0.3-0.5 volume of blood filling its chamber is pushed out for one contraction of the heart to diastole. The remaining blood is a reserve, the use of which is possible in the event of a sharp increase in physical, emotional or other activity.

Left in the chamber, the blood becomes the main determinant that determines the functional reserve of the heart. The larger the reserve volume, the more blood can be supplied to the circulatory system as needed.

When the circulatory apparatus begins to adapt to certain conditions, the systolic volume undergoes a change. In the process of self-regulation, extracardiac nervous mechanisms take an active part. In this case, the main effect is on the myocardium, or rather, on the strength of its contraction. A decrease in the power of myocardial contractions leads to a decrease in systolic volume.

For the average person, whose body is in a horizontal position and does not experience physical stress, it is normal if the DU varies between 70-100 ml.

Factors affecting the IOC

Cardiac output is a variable value, and there are quite a few factors that change it. One of them is the pulse, which is expressed by the heart rate. At rest and in a horizontal position of the body, its average is 60-80 beats per minute. The change in the pulse occurs under the influence of chronotropic influences, and the force is affected by inotropic ones.

Leads to an increase in the minute volume of blood. These changes play an important role in the accelerated adaptation of the IOC to the respective situation. When the body is subjected to extreme exposure, there is an increase in heart rate of 3 or more times compared to normal. The heart rate changes under the chronotropic influence that the sympathetic and vagus nerves have on the sinoatrial node of the heart. In parallel with chronotropic changes in cardiac activity, inotropic influences can be exerted on the myocardium.

Systemic hemodynamics is also determined by the work of the heart. To calculate this indicator, it is necessary to multiply the data of the average pressure and the mass of blood that is pumped into the aorta for a certain time interval. The result informs about how the left ventricle is functioning. To establish the work of the right ventricle, it is enough to reduce the obtained value by 4 times.

If the cardiac output indicators do not correspond to the norm and no external influences are observed, then the fact indicates an abnormal work of the heart, therefore, the presence of a pathology.

Decreased cardiac output

The most common causes of low cardiac output are violations of the main ones. These include:

• damaged myocardium;
• clogged coronary vessels;
• abnormal heart valves;
• disturbed metabolic processes occurring in the heart muscle.

In the case when, with a decrease in cardiac output, the tissues are no longer supplied with nutrients, cardiogenic shock is possible.

The main reason leading to a decrease in cardiac output lies in the insufficient supply of venous blood to the heart. This factor negatively affects the IOC. The process is due to:

• a decrease in the amount of blood involved in the circulation;
• a decrease in tissue mass;
• blockage of large veins and expansion of ordinary ones.

A decrease in the amount of circulating blood contributes to a decrease in the IOC to a critical threshold. In the vascular system, a lack of blood begins to be felt, which is reflected in its amount returned to the heart.

With fainting caused by disorders in the nervous system, small arteries undergo expansion, and veins increase. The result is a decrease in pressure and, as a result, an insufficient volume of blood entering the heart.

If the vessels supplying blood to the heart undergo changes, their partial overlap is possible. This immediately affects the peripheral vessels, which are not involved in the supply of blood to the heart. As a result, the reduced amount of blood sent to the heart causes low cardiac output syndrome. Its main symptoms are:

• drop in blood pressure;
• reduced heart rate;
• tachycardia.

This process is accompanied by external factors: cold sweat, small volume of urination and discoloration of the skin (pallor, blue).

The final diagnosis is made by an experienced cardiologist after a thorough study of the test results.

Increased cardiac output

The level of cardiac output depends not only on physical activity, but also on the psycho-emotional state of a person. The work of the nervous system can reduce and increase the IOC.

Sports activities are accompanied by an increase in blood pressure. Accelerating metabolism contracts skeletal muscles and dilates arterioles. This factor allows the necessary amount of oxygen to be supplied to the muscles. Loads lead to narrowing of large veins, increased heart rate and an increase in the strength of contractions of the heart muscle. Increased pressure causes a powerful blood flow to the skeletal muscles.

Increased cardiac output is most often observed in the following cases:

• arteriovenous fistula;
• thyrotoxicosis;
• anemia;
• lack of vitamin B.

In an arteriovenous fistula, an artery connects directly to a vein. This phenomenon is called a fistula and is represented by two types. Congenital arteriovenous fistula is accompanied by benign formations on the skin and can be located on any organ. In this variant, it is expressed by embryonic fistulas that have not reached the stages of veins or arteries.

Acquired arteriovenous fistula is formed under the influence of external influence. It is created if there is a need for hemodialysis. Often, a fistula is the result of catheterization, as well as a consequence of surgical intervention. Such a fistula sometimes accompanies penetrating wounds.

A large fistula provokes an increased cardiac output. When it takes a chronic form, heart failure is possible, in which the IOC reaches critically high levels.

Thyrotoxicosis is characterized by rapid heart rate and high blood pressure. In parallel with this, not only quantitative changes in the blood occur, but also qualitative ones. An increase in the level of thyraxin is promoted by an abnormal level of erythropatin and, as a result, a reduced erythrocyte mass. The result is increased cardiac output.

With anemia, the viscosity of the blood decreases and the heart has the ability to pump it in large quantities. This leads to increased blood flow and a faster heart rate. Tissues receive more oxygen, respectively, increases cardiac output and IOC.

Vitamin B1 deficiency is the cause of many pathologies

Vitamin B 1 is involved in blood formation and has a beneficial effect on blood microcirculation. Its action significantly affects the work of the heart muscles. Lack of this vitamin contributes to the development of beriberi disease, one of the symptoms of which is impaired blood flow. With an active metabolism, tissues stop absorbing the nutrients they need. The body compensates for this process by expanding the peripheral vessels. Under such conditions, cardiac output and venous return may exceed the norm by two or more times.

Fraction and diagnosis of cardiac output

The concept of ejection fraction was introduced into medicine in order to determine the performance of the heart muscles at the time of contraction. It allows you to determine how much blood has been pushed out of the heart into the vessels. Percentage is selected for the unit of measure.

The left ventricle is chosen as the object of observation. Its direct connection with a large circle of blood circulation allows you to accurately determine heart failure and identify pathology.

The ejection fraction is assigned in the following cases:

• with constant complaints about the work of the heart;
• pain in the chest;
• shortness of breath
• frequent dizziness and fainting;
• low efficiency, rapid fatigue;
• leg swelling.

The initial analysis is performed using an ECG and ultrasound equipment.

Fraction norm

During each systolic state, the heart of a person who does not experience increased physical and psycho-emotional stress ejects up to 50% of blood into the vessels. If this indicator noticeably begins to decrease, there is insufficiency, which indicates the development of ischemia, myocardial pathologies, etc.

A - normal fraction, B - 45% fraction

An indicator of 55-70% is taken as the norm of the ejection fraction. Its fall to 45% and below becomes critical. To prevent the negative consequences of such a decrease, especially after 40 years, an annual visit to a cardiologist is necessary.

If the patient already has pathologies of the cardiovascular system, then in this case it becomes necessary to determine the individual minimum threshold.

After conducting a study and comparing the data obtained with the norm, the doctor makes a diagnosis and prescribes appropriate therapy.

Ultrasound does not allow revealing the full picture of the pathology and, since the doctor is more interested in identifying the cause of this ailment, it is often necessary to resort to additional studies.

Low fraction treatment

A low level of cardiac output is usually accompanied by general malaise. To normalize the health of the patient, outpatient treatment is prescribed. During this period, the work of the cardiovascular system is constantly monitored, and the therapy itself involves taking medications.

In especially critical cases, it is possible to perform a surgical operation. This procedure is preceded by the identification of a severe defect in the patient or serious violations of the valvular apparatus.

Surgery becomes inevitable when low cardiac output becomes life-threatening for the patient. Basically, ordinary therapy is enough.

Self-treatment and prevention of low ejection fraction

To normalize the ejection fraction, you must:

• Introduce control over the fluids taken, reduce their volume to 1.5-2 liters per day.
• Avoid salty and spicy foods.
• Switch to diet foods.
• Reduce physical activity.

As preventive measures to avoid deviations from the norm of the fraction of cardiac output, are:

• rejection of bad habits;
• maintenance of the daily routine;
• the use of iron-containing foods;
• exercises and light gymnastics.

At the slightest malfunction in the work of the heart, or even suspicion of these manifestations, it is necessary to immediately see a cardiologist. Timely detection of pathology greatly simplifies and accelerates its elimination.

Today, in the age of technology, the development of cardiovascular diseases causes quite serious concerns not only among employees of medical organizations, but also in the upper levels of government. That is why more and more new strategies are being developed to reduce the diseases in question, scientific research is being actively funded that will allow us to achieve these goals in the future.

One of the directions in the treatment of patients with cardiovascular diseases is the prevention and treatment of cardiac pathology. If in this area some of the diseases can be successfully treated, others still remain "intractable" due to the lack of techniques and other necessary components of proper treatment. This article discusses the concepts of cardiac output, its norms and methods of treatment, the ejection fraction of the heart (the norm in children and adults).

Current position

Due to the increase in life expectancy among the elderly, the prevalence of cardiac pathology, especially with impaired ejection fraction, is increasing in this group. In recent years, proven methods of drug treatment and the use of resynchronizing devices, a cardioverter-defibrillator have been developed that prolong life and improve its quality in patients with this pathology.

However, the methods of treating the pathology of the heart with a normal fraction have not been determined, the treatment of this pathology remains empirical. There are also no proven treatments for acute forms of cardiac decompensation (pulmonary edema). Until now, the main drugs in the treatment of this condition are diuretics, oxygen and nitro drugs. The ejection fraction of the heart, its norm, its pathology, require a serious approach to the problem.

It is possible to visualize the heart muscle and determine the work (atria, ventricles) using Doppler cardiography. To understand, examine its ability to contract (systolic function) and relax (diastolic function) of the myocardium.

Fraction values

The ejection fraction of the heart, the norm of which is discussed below, is the main instrumental indicator that characterizes the strength of the heart muscle.

Ejection fraction values ​​obtained with Doppler cardiography:

• Normal readings are greater than or equal to 55%.
• Slight deviation - 45-54%.
• Moderate deviation - 30-44%.
• The expressed deviation is less than 30%.

If this indicator is less than 40%, the "power of the heart" is reduced. Normal values ​​are above 50%, "heart strength" is good. Allocate a "gray zone" of 40-50%.

Heart failure is a combination of clinical manifestations, biochemical markers, research data (electrocardiography, cardiac dopplerography, lung radiography) that occur with a decrease in the force of heart contraction.

There are symptomatic and asymptomatic, systolic and diastolic heart failure.

Relevance of the problem

In the last 20 years, the incidence of heart failure among Europeans has been decreasing. But the number of cases in the middle and older groups of the population is increasing due to the increase in life expectancy.

According to European studies (conducting ECHOCG), a decrease in ejection fraction was found in half of patients with symptomatic heart failure and in half of asymptomatic patients.

Patients with heart failure are less able to work, their quality of life and its duration are reduced.

The treatment of these patients is the most expensive for them and for the state. Therefore, the search for ways to prevent the occurrence, early diagnosis and effective treatment of heart disease remains relevant.

Studies conducted in recent decades have proven the effectiveness of a number of groups of drugs to improve prognosis, reduce mortality in patients with low cardiac fraction:

• adenosine-converting enzyme inhibitors ("enalapril");
• angiotensin II antagonists ("Valsartan");
• beta-blockers ("Carvedilol");
• aldosterone blockers ("Spironolactone");
• diuretics ("torasemide");
• "Digoxin".

Causes of heart failure

Heart failure is a syndrome that is formed as a result of a violation of the structure or work of the myocardium. Pathology of conduction or heart rhythm, inflammatory, immune, endocrine, metabolic, genetic, pregnancy can cause heart weakness with or without ejection fraction.

Causes of heart failure:

Ischemic heart disease (more often after a heart attack);

Hypertension;

Combination of coronary artery disease and hypertension;

Idiopathic cardiopathy;

Atrial fibrillation;

Valve defects (rheumatic, sclerotic).

Heart failure:

Systolic (ejection fraction of the heart - the norm is less than 40%);

Diastolic (ejection fraction 45-50%).

Diagnosis of systolic heart failure

Diagnosis of systolic heart failure involves:

1. ejection fraction of the heart - the norm is less than 40%;

2. stagnation in the circles of blood circulation;

3. changes in the structure of the heart (scars, foci of fibrosis, etc.).

Signs of blood stasis:

Increased fatigue;

Dyspnea (shortness of breath), including orthopnea, nocturnal paroxysmal dyspnea - cardiac asthma;

Hepatomegaly;

Expansion of the jugular veins;

Crepitus in the lungs or pleural effusion;

Murmurs on auscultation of the heart, cardiomegaly.

The combination of several of the above symptoms, the presence of information about heart disease helps to establish heart failure, but the Doppler ultrasound of the heart with the definition of structural changes and assessment of myocardial ejection fraction is decisive. In this case, the ejection fraction of the heart will be decisive, the norm after a heart attack of which will be definitely different.

Diagnostic criteria

Criteria for diagnosing heart failure with a normal fraction:

Ejection fraction of the heart - the norm is 45-50%;

Stagnation in a small circle (shortness of breath, crepitus in the lungs, cardiac asthma);

Impaired relaxation or increased myocardial stiffness.

To exclude heart failure in recent years, biological markers have been determined: atrial natriuretic peptide (acute heart failure - more than 300 pg / ml, with chronic heart failure - more than 125 pg / ml). The level of the peptide will help in determining the prognosis of the disease, choosing the optimal treatment.

Patients with a preserved cardiac fraction are usually older and more often women. They have many comorbidities, including arterial hypertension. In these patients, the plasma level of type B is lower than in patients with a low fraction, but higher than in healthy people.

Tasks for doctors in treating patients

The goals of treating patients with heart failure when the ejection fraction of the heart is above normal:

Relief of the symptoms of the disease;

Reducing the number of readmissions;

Prevention of premature death.

The first step in the correction of heart failure is non-drug treatment:

Limitation of physical activity;

Restriction of salt intake;

fluid restriction;

Weight loss.

Treatment of patients with reduced EF

Step 1: diuretic ("Torasemide") + angiotensin-converting enzyme inhibitor ("Enalapril") or an angiotensin II receptor blocker ("Valsartan") with a gradual increase in dose to a stable state + a beta-blocker ("Carvedilol").

If symptoms persist, step 2: add an aldosterone antagonist (Veroshpiron) or angiotensin II receptor antagonist.

If the symptoms persist, it is possible to add Digoxin, Hydralazine, nitropreparations (Cardiket) to the treatment and / or perform invasive interventions (installation of resynchronizing devices, implantation of a cardioverter-defibrillator, heart transplantation), after having previously performed an ultrasound of the heart. The ejection fraction, the norm of which is described above, in this case is determined by ultrasound.

Modern tactics for the treatment of heart failure with angiotensin II receptor blockers, beta-blockers, aldosterone blockers, diuretics, nitrates, hydralazine, digoxin, omacor, if necessary, the installation of resynchronization devices and cardioverter defibrillators in the last two decades has led to a significant increase in the survival rate of patients with terminal forms of this disease. This poses new challenges for doctors and researchers.

The search for methods for replacing scar tissue of the myocardium remains relevant.

Conclusion

Thus, from the presented article, one can see the practical value of the methods undertaken by doctors. The ejection fraction of the heart (norm and pathology) has not yet been fully studied. And although medicine is currently not yet perfect to combat the pathologies under consideration, one must hope and invest a sufficient amount of investment in the development and development of scientific research in this area. After all, the development of the medical industry mainly depends on scientists. Therefore, public authorities should provide support to all scientific medical institutions that are trying to move the issue under consideration.