Know Your EF A Community Education Campaign Julie Warren RN BSN SCRN Community Education Coordinator 2016

What is Ejection Fraction (EF) and what does it mean to me? With each heartbeat, the heart contracts (or squeezes) and relaxes. Every contraction pushes blood out of the two pumping chambers (ventricles). When the heart relaxes, the ventricles refill with blood. The ejection fraction (EF) refers to the amount, or percentage, of blood that is pumped (or ejected) out of the ventricles with each contraction.

What does my EF mean to me? This percentage, or EF number, helps your health care provider determine if you have heart failure or other types of heart disease. A normal heart pumps just over half the heart's volume of blood with each beat – a normal EF is 50 to 75 percent. Ejection Fraction Numbers: 50-75% Heart's pumping ability is Normal 36-49% Heart's pumping ability is Below Normal 35% and Below Heart's pumping ability is Low

How do I find out what my EF is? EF is typically measured by a simple, painless test called an echocardiogram. A special imaging machine uses sound waves to create a videotaped image of the heart, showing the four chambers of the heart, the valves and how well the heart is pumping. Most often, the left ventricle, the heart’s main pumping chamber, is measured during an echocardiogram. A normal left ventricular ejection fraction (LVEF) is 50 to 75 percent. Other tests used to measure EF include cardiac catheterization, magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine scans. A physician order is needed to have an echocardiogram performed.

Heart Failure A low EF number is an early sign of heart failure. This is a condition where the heart does not pump enough blood to the rest of the body. With treatment, many people live well with heart failure. As blood travels from the lungs to the heart, it may back up. If fluid stays in the lungs, breathing becomes difficult. The build up of fluid is the reason for the term “congestive heart failure.” A heart that is “failing” has damaged or stretched muscle. The damage can impair the electrical system in the heart. If this happens, the heartbeat may be too fast, too slow, or unsteady. Heart rhythm problems are common in people with heart failure.

Low EF and Heart Failure If you have a low EF number, it is important that you recognize the signs of heart failure. In the early stages, people with heart failure might not be aware of any symptoms. But as it progresses, one or more of the following symptoms may begin to appear: Fatigue (feeling tired all the time) Shortness of breath Swelling in the feet Chronic coughing or wheezing Rapid or irregular heartbeat Confusion If you have heart disease, your doctor will check your EF periodically, closely monitoring your condition. In the early stages, people with heart failure might not be aware of any symptoms. But as it progresses, one or more of the following symptoms may begin to appear: Shortness of breath (dyspnea) – A feeling of breathlessness, as if you can’t get enough air, may come on during physical activity. In more advanced heart failure, shortness of breath occurs at rest or can awaken patients from sleep. Propping yourself up with extra pillows may help you breathe more easily at night. Fatigue – Activities that did not feel strenuous to you before, such as walking or climbing stairs, may easily tire you out. You may even feel exhausted while resting, when you haven’t been active at all. Chronic coughing or wheezing – Fluid congestion (a buildup of fluid in the lungs) is common with heart failure, and is the reason why doctors often refer to it as “congestive heart failure” (CHF). This congestion can make you wheeze and cough. Some people cough up mucous or phlegm. Fluid retention or swelling – Fluid also can build up in other parts of your body, such as your feet, ankles, legs, and abdomen. Swelling, or edema, is the most obvious sign of fluid buildup, but weight gain also may be a signal. This fluid buildup in the abdomen makes some people lose their appetite or feel nauseated. Rapid or irregular heartbeat – Your weakened heart may try to beat faster to send more blood through your system, making you feel like your heart is racing. Or it may trigger an arrhythmia, which can cause palpitations, heart pounding, or other symptoms. Confusion – The reduced blood flow to your brain may cause feelings of confusion, impaired thinking, or mental sluggishness.

Improving your EF Depending on your EF number, your doctor may make recommendations to help you improve your EF. In some cases, medication may be prescribed. There are also other things you can do to improve how well your heart pumps. Limit Salt – Limiting salt (sodium) to 2,000 mg a day is an important part of maintaining a healthy heart and treating heart failure. With a low EF, your kidneys get less blood than they should. This makes them unable to rid the body of excess water and salt. Eating too much salt can lead to even more fluid buildup. It also increases your blood pressure, which makes an already weakened heart work harder. Manage Your Fluids – With a low EF, blood can back up in your lungs and force fluid into the breathing spaces. The fluid then builds up, making it difficult to breathe. Excess fluid can also cause weight gain and swelling. Your doctor will recommend the amount of fluids you should have daily, depending on your EF. Exercise Regularly – Exercise can help strengthen your heart and improve how well it pumps blood to the rest of the body. All it takes is 30 minutes a day of activity, even if that activity is walking. Talk to your doctor about an exercise program that is right for you.

Improving your EF Many people who have a reduced EF can benefit from a medical device called an implantable cardiac defibrillator (ICD). An ICD is a pacemaker-like device that treats ventricular fibrillation (VF), the deadly heart rhythm that causes sudden cardiac arrest (SCA). Several large clinical studies have been conducted in recent years to see if ICDs could help prevent SCA in those people whose heart muscle, and its pumping ability, is damaged by a heart attack. People in the studies had an ejection fraction (EF) of 40 or below. In these studies, survival rates were significantly higher for people with ICDs compared to those who received traditional medical care.

Improving your EF An abnormally low EF is the single most important factor in predicting the risk of sudden cardiac death (dying from an abnormal heart rhythm). Follow treatment plans, and take all medications as prescribed. Report any new symptoms or changes in existing symptoms to your doctor/health care provider as soon as possible.

Risk factors for Heart Failure While in some cases there is no apparent reason the heart would be weakened, some conditions can damage the heart and weaken the heart muscle. These conditions include: Coronary artery disease, especially with a prior heart attack High Blood Pressure A virus An arrhythmia (irregular heart rhythm) Diabetes Diseases of the heart muscle or valve

Treating Heart Failure Treatment of heart failure is aimed towards living longer, reducing symptoms, and improving quality of life. Treatment options include the following: Diet and lifestyle changes Medications Treatment of underlying causes, such as clogged arteries, heart valve disease, High Blood Pressure, and arrhythmias Cardiac resynchronization therapy (CRT) or other implantable cardiac devices Surgery to repair structural damage Heart transplantation

Heart Disease Prevention and Treatment Make healthy lifestyle choices. Living a “heart healthy” life is the best way to reduce the chances of developing heart disorders. Exercising regularly, maintaining a healthy weight, and eating a healthy, low-fat diet with plenty of vegetables, fruits, and other vitamin-rich foods are the cornerstones of “heart healthy” living. Stop smoking and avoid secondhand smoke (smoke from other people). Tobacco contributes to as much as one-third of all heart disease. Avoid or limit the intake of caffeine, alcohol, and other substances that may contribute to abnormal heart rhythms or heart disease. Avoid unnecessary stress, such as anger, anxiety, or fear, and find ways to manage or control stressful situations that cannot be avoided. Have regular physical exams and tell your doctor right away about any unusual symptoms you have. Talk to a doctor about treating health problems that may contribute to abnormal heart rhythms and heart disease, including atherosclerosis (“clogged” arteries), heart valve damage, High Blood Pressure, high cholesterol, diabetes, and thyroid disease. Prevent heart disease by lowering risk factors that can lead to heart disease or cardiac heart rhythm problems, and by monitoring and treating any existing heart problems.

If you have Heart Failure

Questions to ask your doctor: Should I be concerned with my EF number? Do I need to have my EF rechecked? (And when?) Is there anything I should do about my EF? What else can I do to monitor my heart health? Do I need additional tests or treatments? Do I need to see another doctor who specializes in heart rhythm problems? Do I need to be seen by the Heart Failure Clinic?

Free Health Information! Early Heart Attack Care Heart Attack, Stroke, and Lung Cancer Prevention for the Community Know Your EF, A Community Education Campaign A Matter of Life and Breath-Lung Cancer Prevention Spot a Stroke F.A.S.T!

References http://www.hrsonline.org/Patient-Resources/The-Normal-Heart/Ejection-Fraction#sthash.wYhE7V5E.dpuf -- Follow us: @hrsonline on Twitter | HeartRhythmSociety on Facebook http://www.hrsonline.org/Patient-Resources/Heart-Diseases-Disorders/Heart-Failure#sthash.zs6M2PVe.dpuf -- Follow us: @hrsonline on Twitter | HeartRhythmSociety on Facebook

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