Decrease in fractional ejection. From other organs

Patients who have received a referral for medical diagnostics of the heart and blood vessels meet such a thing as ejection fraction. It is measured during ultrasound, contrast x-ray and echocardiography.

In this article, the reader will get acquainted with the definition of "cardiac output", norms and interpretation, as well as learn about methods of treatment and prevention.

If you have any questions, you can contact the specialists of the portal.

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Concepts and symptoms

The 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 a percentage of the volume of blood entering the vessels in the state of ventricular systole. For example, in the presence of 100 ml, 65 ml enters the vascular system, so the cardiac output will be 65%.

Basically, measurements are carried out in the left ventricle, since from it the blood enters the circulation in a large circle. If there is a lack of blood in this ventricle, then this causes heart failure, which leads to the development of diseases of the organ.

The ejection fraction is not assigned to all patients, but only to those who complain of:

• pain syndrome in the chest;
• systematic interruptions in the work of the body;
• tachycardia;
• dyspnea;
• frequent dizziness and fainting;
• swelling of the lower extremities;
• rapid fatigue and weakness;
• decrease in productivity.

As a rule, the first study is an electrocardiogram and ultrasound. These examinations allow you to find out to what extent the cardiac output of both the left ventricle and the right one occurs. Diagnostics is characterized by low price, high information content, and there is no specific training. The availability of the procedure is due to the fact that any ultrasonic equipment is able to provide data on the fraction.

Normal fraction ejection

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 decline to the bar of less than 50%, then deficiency is diagnosed. As a result of a decrease in volume, the myocardium develops, ischemia, defect, etc.

The ejection fraction varies in the range of 55-70 percent - this is the norm. A drop to 35-40 percent would entail dangerous outages. To prevent a fatal fall, it is necessary to visit a cardiologist at least once a year. Persons over the age of 40 are mandatory procedure. Symptomatic picture, described above, is a good reason to contact a qualified cardiologist.

Cardiac output in the diagnosis of a patient with pathologies in the cardiovascular system important priority is to define an 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 ultrasound examination, the diagnostician draws up a protocol, where he enters all the received data on the state of the left ventricle. Subsequently, the information is decrypted. When pathologies are detected, 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 studied organ. Decoding occurs by comparing the information received with the norm-table.

• ejection fraction, range: 55 -60%;
• atrial size right camera: 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;
• left chamber atrial size: 1.9 to 4 cm.

The above indicators must be considered in aggregate volume. Deviation from the norm of one is not a suspicion of a pathological process, but may require additional diagnosis.

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How to treat a low fraction level?

Having information about the rate of cardiac output, the reader can analyze the performance of the body. When the output of the left ventricle is below normal, it is recommended to short time consult a cardiologist. 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 feeling unwell, swelling and shortness of breath. How to increase the size of the fraction? We live in an era of progressive medicine, therefore, in the arsenal of doctors to increase the release of blood into the vessels, therapy occupies the first place. Basically, the ward is on outpatient treatment, during which experts monitor the activity of the heart and vascular system. In addition to medical treatment, surgery 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 intake;
• moderate physical activity;
• reception medicines: stimulants urinary tract, inhibitors, adrenaline blockers, digoxin, etc.

You can restore the blood supply surgical method. As a rule, operations are prescribed for patients who have been diagnosed with severe heart disease or valvular disease. Often, the valves are resected and prostheses are installed. This approach allows us to normalize heartbeat, 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 heart disease vascular system you can easily keep the fraction normal.

• daily charge;
• the use of foods rich in iron;
• do not abuse alcohol-containing drinks and tobacco;
• follow a healthy regimen;
• do aerobics 2-3 times a week;
• Choose foods that are low in salt.

The main key is aerobics. There is an opinion that in diseases of the heart and blood vessels physical exercise harmful. It is a myth.

Harm can only bring weight lifting, ie. gym patients are prohibited. Aerobic exercises, on the contrary, strengthen the walls of blood vessels and do not overload the heart. Such exercises improve muscle function by removing oxygen from the blood. It is necessary to engage in gradually increasing the load.

According to the statistics of the 20th century, elderly people most often suffered from cardiovascular diseases. To date, 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 annual medical examination not only at the cardiologist, but also other doctors. Remember that only you are responsible for your health!

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If you have already passed ultrasound procedure kidneys or, for example, organs abdominal cavity, then you remember that for an approximate decoding of their results, most often you do not have to contact a doctor - you can find out basic information even before visiting a doctor, by reading the conclusion yourself. The results of an ultrasound of the heart are not so easy to understand, so it can be difficult to unravel them, especially if you analyze each indicator by number.

You can, of course, just look at the last lines of the form, where the general summary of the study is written, but this also does not always clarify the situation. In order for you to better understand the results obtained, we present the basic norms of ultrasound of the heart and possible pathological changes that can be established by this method.

Norms in ultrasound for heart chambers

To begin with, here are a few numbers that are sure to be found in every conclusion of Doppler echocardiography. They reflect various options structures and functions of individual chambers of the heart. If you are a pedant and take a responsible approach to decrypting 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. In different sources, the data may vary slightly; here are the figures based on the materials of the manual "Norms in Medicine" (Moscow, 2001).

Left ventricular parameters

Mass of the myocardium of the left ventricle: 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 size (EDD) of the left ventricle(the size of the ventricle in centimeters, which it has at rest): 4.6 - 5.7 cm

End systolic size (SSR) of the left ventricle(the size of the ventricle that it has during contraction): 3.1 - 4.3 cm

Wall thickness in diastole(outside heart beats): 1.1 cm

With hypertrophy - an increase in the thickness of the wall of the ventricle, due to too much load on the heart - this indicator increases. The numbers 1.2 - 1.4 cm indicate slight hypertrophy, 1.4-1.6 - medium, 1.6-2.0 - significant, and a value of more than 2 cm indicates high hypertrophy.

Ejection Fraction (EF): 55-60%.

At rest, the ventricles fill with blood, which is not completely ejected from them during contractions (systole). The ejection fraction shows how much blood is relative to its total ejects the heart with each contraction, normally it is a little more than half. With a decrease in the EF, they speak of heart failure, which means that the organ does not pump blood efficiently, 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

Thickness at rest (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 some heart defects.

Right Atrium Parameters

For this chamber of the heart, only the value of the EDV is determined - the volume at rest. A value of less than 20 ml indicates a decrease in EDV, an indicator 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.

Parameters of the left atrium

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 your state of health. You can simply compare your performance 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; For a broader coverage of it, the volume of this article is too small.

Norms in ultrasound for heart valves

As for deciphering the results of the examination of the valves, it should present an easier task. It will be enough for you to look at general conclusion about their condition. The main, most frequent pathological processes only two: stenosis and valve insufficiency.

term "stenosis" a narrowing of the valve opening is indicated, in which the upper chamber of the heart hardly pumps blood through it and may undergo hypertrophy, which we discussed in the previous section.

Failure is the opposite state. If the valve leaflets, which normally prevent the backflow 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 back, reducing the efficiency of the organ.

Depending on the severity of the violations, stenosis and insufficiency can be 1,2 or 3 degrees. The higher the degree, the more serious the pathology.

Sometimes in the conclusion of an ultrasound of the heart you can find such a definition as "relative insufficiency". At given state the valve itself remains normal, and blood flow disorders occur due to the fact that pathological changes occur in adjacent chambers of the heart.

Norms in ultrasound 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 region of the vascular discharge, in its upper part, and between it and the heart itself there is a slit-like cavity.

Most frequent pathology pericardium is an inflammatory process, or pericarditis. In pericarditis, adhesions can form between the pericardial sac and the heart and fluid can accumulate. Normally, its 10-30 ml, 100 ml indicates a small accumulation, and over 500 - 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 a 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, the interpretation of the results of such complex research, as ECHO-cardiography, should be provided to a specialized specialist, and not try to do it on your own, long and unsuccessfully “poking around” in the numbers and trying to understand what these or those 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, wrong conclusions about your health.

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The norm of the EF indicator

To assess the work of the heart, namely the left ventricle, the Teicholtz or Simpson formulas are used. I must say that it is from this department that the blood enters the general circulation and, with left ventricular failure, it most often develops clinical picture heart failure.

The closer this indicator is to the norm, the better the main "motor" of the body is reduced and the more favorable the prediction for life and health. If the value obtained is far short of the norm, then we can conclude that internal organs don't get required amount oxygen and nutrients with the blood, which means that 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 Teicholtz formula is used no less frequently. The results of both methods can differ within 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 about the ability of the myocardium to contract. If the value obtained fluctuates between 35–40%, they speak of advanced heart failure. And even lower rates are fraught with deadly consequences.

Reasons for the decrease in EF

Low values ​​can be caused by pathologies such as:

1. Cardiac ischemia. At the same time, the blood flow coronary arteries decreases.
2. History of myocardial infarction. This leads to the replacement of normal heart muscles with scars that do not have the necessary ability to contract.
3. Arrhythmia, tachycardia and other ailments that disrupt the rhythm of the body's main "motor" and conduction.
4. Cardiomyopathy. It consists in an increase or lengthening of the heart muscle, which is due to hormonal failure, prolonged hypertension, and heart defects.

Symptoms of the disease

The diagnosis of "low ejection fraction" can be made on the basis of 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 can be provoked by long walking, as well as performing the simplest work housework: mopping, cooking.

In the process of impaired blood circulation, fluid retention occurs, which leads to the appearance of edema, and in severe cases, they affect the internal organs and tissues. A person begins to suffer from abdominal pain with right side, and stagnation 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 do echocardioscopy at least once a year, especially for people with heart diseases.

An increase in EF to 70-80% should also alert, as this may be a sign that the heart muscle cannot compensate for the growing heart failure and seeks to eject as much blood as possible into the aorta.

As the disease progresses, the LV work indicator will decrease, and it is echocardioscopy in dynamics that will catch this moment. A high ejection fraction is characteristic of healthy people, in particular, athletes, whose heart muscle is sufficiently trained and able to contract with greater force than that of an ordinary person.

Treatment

It is possible to increase the reduced EF. To do this, doctors use not only drug therapy, but also other methods:

1. Prescribe drugs to improve myocardial contractility. These include cardiac glycosides, after which there is a noticeable improvement.
2. To prevent heart overload excess fluid, urge to follow a diet with a restriction of salt to 1.5 g per day and fluid intake to 1.5 liters per day. Along with this, diuretics are prescribed.
3. Organoprotective agents are prescribed to help protect the heart and blood vessels.
4. A decision is made about surgery. For example, valve prosthetics are performed, shunts are installed on coronary vessels etc. However, an extremely low ejection fraction may be a contraindication to the operation.

Prevention

Prevention to prevent the development of heart disease is of great importance, especially in children. In the age of high technology, when most work is performed by machines, as well as the constantly deteriorating environmental conditions of life and malnutrition the risk of developing heart disease increases significantly.

Therefore, it is very important to eat right, exercise, visit more often. fresh air. It is this lifestyle that will ensure normal contractility of the heart and muscle fitness.

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The amount of blood ejected by the ventricle of the heart into the arteries per minute is an important indicator functional state of cardio-vascular system(SSS) 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 gives stroke volume , also called systolic volume or systolic ejection . Stroke volume is the amount of blood ejected from the ventricle of the heart arterial system for one systole. (If we divide the IOC by the heart rate per minute, we get systolic volume (CO) of blood flow.) With a contraction of the heart equal to 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 definition of IOC and CO is widely used in the clinic.

Ejection Fraction (EF) - expressed as a percentage of the ratio of the stroke volume of the heart to the end-diastolic volume of the ventricle. PV at rest healthy person 50-75%, and during physical activity can reach 80%.

The volume of blood in the cavity of the ventricle, which it occupies before its systole is end-diastolic volume (120-130 ml).

End-systolic volume (ESO) 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 with an increase in CO at loads. Normally, it is 15-20% of the end-diastolic.

The volume of blood in the cavities of the heart, remaining with the full implementation of the reserve volume, at maximum systole is residual volume. CO and IOC values ​​are not constant. With muscular activity, the IOC increases to 30-38 liters due to the increased heart rate and the increase in COQ.

A number of indicators are used to assess the contractility of the heart muscle. These include: ejection fraction, the rate of expulsion of blood in the phase of rapid filling, the rate of pressure increase in the ventricle during the period of stress (measured by probing the ventricle) /

The rate of expulsion of blood changed by Doppler ultrasound of the heart.

Pressure increase rate in the cavities is considered ventricular is considered one of the most reliable indicators of myocardial contractility. For the left ventricle, the value of this indicator is normally 2000-2500 mm Hg / s.

A decrease in the ejection fraction below 50%, a decrease in the rate of blood expulsion, and a rate of pressure increase indicate a decrease in myocardial contractility and the possibility of developing insufficiency in the pumping function of the heart.

The IOC value divided by the body surface area in m 2 is defined as cardiac index (l / min / m 2).

SI \u003d IOC / 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 × m 2.

IOC, UOC and SI unite general concept cardiac output.

If the IOC and blood pressure in the aorta (or pulmonary artery) are known, it is possible to determine the external work of the heart

P = IOC × BP

P is the work of the heart in minutes in kilogram meters (kg / m).

IOC - minute volume of blood (l).

BP is the pressure in meters of water column.

During 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 expulsion of blood into the arteries (aorta and pulmonary artery). When the heart cannot pump all the blood into the arteries with 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 in case of defects, hypertension.

2. Heart failure in case of myocardial damage: infections, intoxications, beriberi, impaired coronary circulation. This reduces the contractile function of the heart.

3. mixed form insufficiency - with rheumatism, dystrophic changes in the myocardium, etc.

The whole complex of manifestations of the activity of the heart is recorded using various physiological methods - cardiography: ECG, electrokymography, ballistocardiography, dynamocardiography, apical cardiography, ultrasound cardiography, etc.

The diagnostic method for the clinic is the electrical registration 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. When the heart moves, the illumination of the photocell changes. This is recorded by the oscilloscope in the form of a curve of contraction and relaxation of the heart. This technique is called electrokymography.

Apical cardiogram is registered by any system that captures small local displacements. The sensor is fixed in the 5th intercostal space above the site of the cardiac impulse. Characterizes all phases cardiac cycle. But it is not always possible to register all phases: the cardiac impulse is projected differently, part of the force is applied to the ribs. Entry at different persons and in one person it may differ, depending on the degree of development of the fat layer, etc.

Research methods based on the use of ultrasound are also used in the clinic - ultrasound cardiography.

Ultrasonic vibrations at a frequency of 500 kHz and above penetrate deeply through tissues being formed by ultrasound emitters applied to the surface of the chest. Ultrasound is reflected from tissues of various densities - from the outer and inner surface heart, from vessels, from valves. The time of reaching the reflected ultrasound to the catching device is determined.

If the reflective surface moves, then the return time of the ultrasonic vibrations changes. This method can be used to record changes in the configuration of the structures of the heart 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:

Cardiac catheterization. An elastic probe-catheter is inserted into the central end of the opened brachial vein and pushed to the heart (into its right half). A probe is inserted into the aorta or left ventricle through the brachial artery.

Ultrasound Scan- the source of ultrasound is introduced into the heart using a catheter.

Angiography is a study of the movements of the heart in the field x-rays and 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 push. During diastole, the heart takes the shape of an ellipsoid. During systole, it takes the form of a ball, its longitudinal diameter decreases, and its transverse diameter increases. The apex during systole rises and presses against the anterior chest wall. In the 5th intercostal space, a cardiac impulse occurs, which can be registered ( apical cardiography). The expulsion of blood from the ventricles and its movement through the vessels, due to reactive recoil, causes oscillations of the whole 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 determined: the first is systolic, the second is diastolic.

systolic the tone is low, drawn out (0.12 s). Several layering components are involved in its genesis:

1. Close component mitral valve.

2. Closing of the tricuspid valve.

3. Pulmonary tone of expulsion of blood.

4. Aortic tone of blood expulsion.

The characteristic of the I tone is determined by the tension of the cusp valves, the tension of the tendon filaments, the papillary muscles, the walls of the myocardium of the ventricles.

Components of blood expulsion occur with wall tension main vessels. I tone is well heard in the 5th left intercostal space. In pathology, the genesis of the first tone involves:

1. Aortic valve opening component.

2. Opening of the pulmonic valve.

3. Tone of stretching of the pulmonary artery.

4. Tone of aortic distension.

Amplification of the I tone can be with:

1. Hyperdynamia: physical activity, emotions.

In violation of the temporary 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 fully open). The third variant of amplification of the first tone has significant diagnostic value.

Weakening of the I tone is possible with mitral valve insufficiency, when the leaflets do not close tightly, with myocardial damage, etc.

II tone - diastolic(high, short 0.08 s). Occurs when the semilunar valves are closed. On the sphygmogram, its equivalent is - incisura. The tone is higher, the higher the pressure in the aorta and pulmonary artery. Well heard in the 2nd intercostal space to the right and left of the sternum. It increases with sclerosis of the ascending aorta, pulmonary artery. The sound of I and II heart sounds most closely conveys the combination of sounds when pronouncing the phrase "LAB-DAB".

Today, in the age of technology, development cardiovascular disease 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, actively funded scientific developments that will help 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, then others still remain "intractable" due to the lack of techniques and other necessary components. 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, methods for treating heart pathology with a normal fraction have not been determined, the treatment of this pathology remains empirical. There are also no proven treatments acute forms 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- 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 declining. 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, it remains relevant to find ways to prevent the occurrence, early diagnosis and effective treatment of heart disease.

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 it is decisive to conduct Dopplerography of the heart to determine structural changes and assessment of myocardial ejection fraction. 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 not 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 angiotensin II receptor blocker (valsartan) with gradual increase doses 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 enough investment in development and development scientific research in this region. 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.

In cardiology, there is the concept of ejection fraction. To an ordinary person this term does not mean anything, although it often sounds from the lips of a cardiologist. It is necessary to understand and study in detail all the issues related to this topic. We have to figure out what the ejection fraction of the heart means, at what level is the norm, and what deviations can be. We will also get acquainted with the symptoms and treatment that is usually prescribed.

What is ejection fraction and why should it be measured?

Let's start the conversation with what ejection fraction means. This term refers to a value that reflects the efficiency of the functioning of the heart muscle. The indicator determines the amount of blood in percentage terms, which is pushed out by the left ventricle as a result of contraction. When calculating the indicator, the ratio of ejected blood relative to its amount, which is in the left ventricle at the moment of relaxation, is determined.

This indicator is extremely important. Deviations from normal level talk about serious problems in the work of the heart, which can cause the development of pathologies of the cardiovascular system and affect the body negative impact. Therefore, it is necessary to diagnose and evaluate the ejection fraction.

How is the ejection fraction calculated?

The process of calculating the indicator is simple, but the results can be used to evaluate the real ability of the myocardium to perform its direct function - to ensure contraction of the heart muscle. For calculations, an ultrasound of the heart is used, which is performed using dopplerography.

There are two methods that underlie the calculation:

1. The Teicholz formula is used in M-modal echocardiography. The object of study is a small part of the ventricle, which is located at the base. The length of the heart section is not taken into account. The results of this method are not particularly accurate when it comes to patients with ischemia. With such a diagnosis, there are areas of the ventricle in which local contractility is impaired. Software automatically makes calculations based on two volume indicators: systolic and diastolic. The size of the heart is also taken into account. For this method of calculation, outdated equipment is used.
2. Simpson's algorithm is a new method that is practiced in modern clinics. This method is also called the disk method. The study takes into account all areas of the myocardium, which are of great importance.

Normal EF

To talk about deviations, you need to study well the norm that characterizes the ejection fraction of the left ventricle. We cannot specify a single indicator that will be equally suitable for every case. And the matter is not only in the individuality of each organism, although this circumstance has a considerable influence on the formation of a normal indicator. It is also necessary to take into account the age of a person, his physiological parameters and many other factors. Even the equipment on which the calculations are made and the formula used determine their normal levels.

The average rate of cardiac output fraction, which is considered generally accepted, is as follows:

1. When using the Simpson formula, the range of 50 - 60% is the norm. the lower limit is at 45%.
2. According to the Teicholtz formula, the lower limit is at the level of 55%. According to this indicator, it is precisely this amount of blood that must enter the aorta so that all internal organs and systems do not experience a lack of oxygen.
3. In the presence of heart failure in adults, the ejection fraction of the heart drops to 45 - 30%. Such results of the study require the appointment of drug treatment, or the patient is offered surgery.
4. Heart ejection fraction values ​​below 35% indicate a high development of other severe pathologies and even sudden death.
5. In children, the norm of the ejection fraction of the heart differs from that which corresponds to an adult. They are on more high level. For newborns, the norm varies between 60 - 80%. As the body grows and develops, the ejection fraction in children tends to generally accepted standards that are characteristic of an adult.

A low cardiac output fraction indicates the inability of the myocardium to produce normal contractions. This situation causes circulatory disorders and oxygen starvation. First of all, the brain suffers.

An overestimation indicates pathological increase heart, in which the myocardium is not able to independently normalize progressive insufficiency of the heart muscle. In this case, the myocardium tends to dump a large amount of blood into the aorta.

Reasons for deviations

There are many reasons that cause a decrease in ejection fraction. On the early stages development of cardiac pathologies, the ejection fraction index does not change. This is explained by the restructuring of the heart muscle under new circumstances. The layer of the myocardium may increase, the heart rate may increase, or changes in the system of small vessels may occur.

With the development of cardiac pathology, the organ wears out and undergoes functional abnormalities, which, in turn, cause the formation of structural disorders. Among such violations is the ejection fraction index. Its decrease may be due to the following situations:

1. A decrease in normal coronary blood flow can be caused by angina pectoris, the death of the muscles of the heart, the formation of scar tissue, ischemic attack, expansion of the walls of the ventricles, and high blood pressure.
2. infectious and inflammatory processes arise due to lesions of the muscular membrane of the myocardium, pathological changes affecting the inner membrane, and diseases of the heart bag.

1. Structural changes in tissues occur with primary, metabolic abnormalities, which lead to a decrease in the thickness of the myocardium.
2. The increased load experienced by the chambers of the heart is the result of the development of congenital structural abnormalities in the structure of the heart muscle, the occurrence of complications as a result of the development of rheumatism and due to high pressure in the pulmonary circulation.
3. Pathologies of the vascular system can also cause changes in the ejection fraction of the heart. The cause of this condition may be inflammatory processes, congenital pathologies, dilated or exfoliated aorta, atherosclerotic plaques, blood clots in the pulmonary vessels.
4. Violations at work endocrine system are the result of failures in the formation of hormones, glucose absorption and the development of diabetes, neoplasms in the pancreas or adrenal glands, overweight.
5. A decrease in cardiac output fraction can be triggered by the influence of toxins (alcohol, caffeine, nicotine, drugs, cardiac glycosides).

As you can see, there are many reasons that can cause violations of the cardiac output fraction. To identify the root cause, it is necessary to undergo a comprehensive diagnosis prescribed by a specialist. This information will allow the physician to prescribe effective treatment and eliminate not only violations of fractional ejection, but also the cause that caused such a state.

Symptoms of a decrease in the indicator

A low ejection fraction responds to various changes in the body. Symptoms are extensive and varied, determined by the root cause, the presence of concomitant diseases, age of the patient and many other factors. The most common are the following symptoms, the presence of which indicates the nature of the problem:

• fatigue that is permanent;
• accumulation of fluid in the abdominal cavity and chest;
• decrease in the physical capabilities of the body;
• difficulty breathing and a constant feeling of lack of air, which is aggravated by the horizontal position of the body;
• frequent dizziness, which can lead to fainting;
• decreased vision;
• pain in the region of the heart muscle;
• swelling in the legs;
• an increase in the size of the liver;
• weight loss that occurs in a short time;
• impaired coordination of movements, loss in space and decreased sensitivity in the arms and legs;
• stool disorders, abdominal pain, nausea and bloody vomit;
• the presence of blood in the stool.

If you identify one of these signs or several at once, you should immediately go to the hospital for diagnosis and diagnosis.

When is treatment required?

Treatment of an increase in low cardiac output fraction is not performed solely on the basis of this result. In any case, it is necessary to identify the cause of such changes and prescribe treatment that will be aimed at eliminating this factor. When prescribing treatment aimed at increasing cardiac output, the source that caused such a pathology is eliminated, and pain is eliminated, the minute volume improves, and the nutrition of the heart is normalized.

Treatment Methods

There are several methods of treatment that allow you to bring the fraction of cardiac output back to normal. The choice of the desired method is carried out on the basis of data obtained as a result of complex diagnostics.

Drug therapy

You can achieve an increase in cardiac output fraction by taking certain groups of drugs:

1. ACE inhibitors have a dilating effect on blood vessels, improve myocardial nutrition, and make the heart more resistant to stress.
2. Beta-blockers reduce heart rate, reduce heart wear, reduce and increase the number of heart zones that are involved in the contractile process.
3. Aldosterone receptor antagonists normalize the level of potassium and sodium, remove fluid from the body.
4. Diuretics.
5. Cardiac glycosides improve the contractile function of the myocardium and restore the conduction of impulses, which is important for violations of the functionality of the heart.

Is there some more additional list drugs that in some cases increase the EF of the heart:

• statins lower cholesterol and protect blood vessels;
• Anticoagulants thin the blood and reduce the chance of developing blood clots.

Some drugs are prescribed along with the main therapy, having an additional effect on the body. These medications include peripheral vasodilators, calcium channel blockers, antiplatelet agents, antiarrhythmic drugs.

Only the attending physician should prescribe drug therapy. It is strictly forbidden to self-medicate, as the disease can worsen and cause serious complications.

Surgical correction

In advanced conditions, when drug treatment does not give the desired results, and a person's life is at risk, surgery is recommended. There are several methods that allow you to increase the ejection fraction of the heart. The choice of technique is based on the indicators and the condition of the person. The two most commonly used surgical procedures are:

1. A defibrillator or stimulator is implanted into the body by conducting open operation on the heart. The device is able to respond to changes in the work of the heart, at the right time it is activated and brings the body back to normal due to electrical action.
2. The impact on different rhythms of the atria and ventricles is to artificially slow down the contractions of the heart. An artificial one is used. The result of such surgical intervention is the restoration of the ducts through which blood can enter the ventricles.

Non-drug treatment

In addition to the main treatment, whether it is medication or surgery, it is necessary to adhere to a number of recommendations that form the basis non-drug treatment. This will increase the chances of recovery, shorten the duration of treatment and strengthen the body. The essence of this treatment is the following principles:

• normalization of the daily routine with 8 hours of sleep;
• moderate and normalized exercises;
• choice of light sport;
• daily unhurried hiking;
• proper and nutritious nutrition;
• massage;
• reduction of stress and nervous shocks;
• maintenance of water balance means daily use 1.5 liters of water, but not more than 2;
• reducing the amount of salt;
• refusal from .

Thus, by increasing the ejection fraction of the heart, you can strengthen your body and prevent many heart diseases. Also to non-drug methods treatments include means traditional medicine. Taking some decoctions allows you to achieve blood thinning, these include willow bark, meadow clover, meadowsweet, yellow sweet clover, hawthorn, rakita and Ginkgo biloba.

Another group of natural remedies has a calming effect on the body, reduces emotional and nervous excitement. For these purposes, it is recommended to take decoctions and infusions from the leaves of valerian, peony, hawthorn and motherwort. You can also make a herbal collection of herbal cudweed, hawthorn flowers, motherwort (two parts), chamomile and cumin.

Traditional medicine can be used only after consulting a doctor. Otherwise, complications may develop and the situation will only worsen.

Prevention of low EF

Everyone can follow the rules of prevention, thus maintaining their body in a healthy state and increasing its ability to resist exposure. negative factors. The essence of prevention is as follows:

• getting rid of excess weight;
• try to avoid stress and conflict;
• adhere to the normal regime of the day, fully relax and sleep for at least 8 hours;
• control blood pressure;
• reduce the consumption of animal fats, replacing them with vegetable ones;
• balance the diet;
• play sports, swim, walk more, sit less;
• give up bad habits.

A low cardiac output fraction is not a sentence, but a disease that can be treated. The sooner the pathology is detected, the easier and more effective the treatment will be, in which there will be no need for surgery.

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 Teicholz 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, can 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 used on equipment that this moment 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. Simpson's algorithm was patented by him in 1989. The identical name for this algorithm is the disk method. At this study ejection fractions, all important areas heart muscle.

Fact! Indicators of 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 FW?

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 this 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.

AT childhood 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 in 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 into the aorta. large quantity blood 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. functional abilities that lead to structural failures. 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- 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 reduction in ejection fraction is not separate disease, but is only provoked by the initial diseases, then 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.

To additional funds 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 deviating the ejection fraction can be applied surgical interventions. The type of surgery depends on individual parameters and pathological conditions patient.

In most cases, the following operational methods are used:

• Implantation of a defibrillator or pacemaker. By 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 the following recommendations must be followed. Only by observing them, and correctly prescribed method of treatment.

Long-term ejection fraction normalization can be achieved:

• Normalize your daily routine by allocating time for good sleep(at least 8 hours);
• Moderate physical exercises. 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 pure drinking water in a 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 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. AT medical purposes used as an alcoholic tincture or extract;
• Rakita. Bush plant, with increased concentration 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 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 available excess weight, it is recommended to reset it;
• Avoid stressful situations and nervous tension;
• Stick to the daily routine good rest and sleep;
• Monitor blood pressure;
• Eat less animal fats, and more vegetable;
• Eat in a balanced way;
• Get rid of seated image life, play sports;
• Stop smoking and drinking alcohol.

What is the forecast for EF deviations?

If the ejection fraction drops to forty percent, then the risk fatality 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 normal process vital activity.

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!