Ejection Fraction Measurement and Heart Failure
What is “ejection fraction”?
Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. An ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out with each heartbeat.
This indication of how well your heart is pumping out blood can help to diagnose and track heart failure.
What’s normal?
- A normal heart’s ejection fraction may be between 50 and 70 percent.
- You can have a normal ejection fraction measurement and still have heart failure (called HFpEF or heart failure with preserved ejection fraction).
- If the heart muscle has become so thick and stiff that the ventricle holds a smaller than usual volume of blood, it might still seem to pump out a normal percentage of the blood that enters it. In reality, though, the total amount of blood pumped isn’t enough to meet your body’s needs.
What’s too low?
- An ejection fraction measurement under 40 percent may be evidence of heart failure or cardiomyopathy.
- An EF from 41 to 49 percent may be considered “borderline.” It does not always indicate that a person is developing heart failure. Instead, it may indicate damage, perhaps from a previous heart attack.
- In severe cases, ejection fraction can be very low.
- Learn ways to improve your low ejection fraction.
What’s too high?
An ejection fraction measurement higher than 75 percent may indicate a heart condition such as hypertrophic cardiomyopathy.
Download HF And Your Ejection Fraction Explained English (PDF) | Spanish (PDF)
Using ejection fraction in diagnosis
When examined using an echocardiogram, a significant number of patients with heart failure are revealed to have normal ventricular ejection fraction. This condition was previously called diastolic heart failure; it’s now referred to as heart failure with preserved ejection fraction.
Your doctor may mention one of these two EF-related scenarios:
- Preserved ejection fraction (HFpEF) – also referred to as diastolic heart failure. The heart muscle contracts normally but the ventricles do not relax as they should during ventricular filling (or when the ventricles relax).
- Reduced ejection fraction (HFrEF) – also referred to as systolic heart failure. The heart muscle does not contract effectively, and therefore less oxygen-rich blood is pumped out to the body.
Tests for measuring EF
Your doctor may recommend one or more of these tests to measure your ejection fraction:
- Echocardiogram (or “echo”) - the most widely used test
- MUGA scan
- CAT scan
- Cardiac catheterization
- Nuclear stress test
Learn more about common tests for diagnosing heart failure.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
Hearing your heart ejection fraction is low can generate a lot of questions, like why it’s low and what can you do to improve it. At Aurora, diagnosing and treating heart conditions is our specialty. With unparalleled expertise, we’re one of the most active cardiovascular programs in Wisconsin. Our experienced team is here to get you the answers – and the right care – you need to keep your heart ejection fraction within normal range.
What is low ejection fraction?
Ejection fraction measures how well your heart is functioning. It’s expressed as a percentage and indicates how much blood your heart is pumping out with each contraction.
For example, an ejection fraction of 60% means your heart is pumping 60% of your blood out of your left ventricle (its main pumping chamber) every time your heart beats. Generally, a normal range for ejection fraction is between 55% and 70%.
Low ejection fraction, sometimes called low EF, is when your ejection fraction falls below the normal range. It means your heart isn’t functioning as well as it should. Your doctor will want to thoroughly check you for a heart condition to find the cause.
A low number can be serious. If your ejection fraction is 35% or below, you’re at high risk of developing a dangerous arrythmia or even heart failure.
Low ejection fraction symptoms
If you have two or more signs of low ejection fraction, particularly if you know you already have a heart condition, see your doctor right away. Symptoms can include:
- Fatigue
- Feeling of fullness or bloating
- Heart palpitations, which feel like fluttering in the chest
- Loss of appetite
- Nausea
- Reduced ability to exercise
- Shortness of breath
- Swelling
Low ejection fraction causes
An ejection fraction that falls lower than the normal range is often a sign of an underlying heart disease. Many different heart and vascular conditions can lead to low ejection fraction, such as:
- Cardiomyopathy, which causes your heart muscle to become enlarged, thick or stiff
- Coronary artery disease, where plaque builds up in the two main arteries that supply blood to your heart and blocks blood flow
- Heart attack, when blood flow to your heart muscle became blocked and damaged
- Heart valve disease, when one or more of your heart valves don’t open and close the way they should
- Systolic heart failure, when your heart’s left ventricle can’t pump blood forcefully enough
Low ejection fraction diagnosis
With advanced technology in labs that are among the best-equipped in the country, we’ll use one or more imaging tests to precisely measure your ejection fraction. These tests may include:
- Radiographic imaging, such as a CT scan or MRI
- Echocardiogram, a heart ultrasound
- Nuclear cardiology imaging, which uses a safe dose of radioactive material to evaluate blood flow through your heart
- Cardiac catheterization, a minimally invasive procedure where we gently guide a thin tube, or catheter, with a tiny camera through a blood vessel to your heart
Find out more about our heart and vascular testing and diagnosis.
Low ejection fraction treatment
Not only are we specialized in treating all kinds of heart conditions, but we also specialize in tailoring a treatment plan just for you. We take the time to get to know you, pinpoint any underlying causes and provide exactly the care you need.
Your care plan will depend on if your low ejection fraction is linked to another heart condition. We may recommend:
- Lifestyle changes, such as getting exercise, losing weight, quitting smoking or reducing salt
- Medication, such as beta blockers or diuretics, to help improve your heart function or get rid of excess fluids
- Biventricular pacemaker implant to help your heart chambers pump blood as they should
- Implantable cardiac defibrillator (ICD), a device that sends small electrical pulses to your heart to restore a healthy rhythm, especially treating those arrythmias that can cause your heart to stop beating
- Heart transplant when other treatments are unable to help dangerously low ejection fraction and severe heart problems