HEART FUNCTION INCLUDING EJECTION FRACTION (EF)

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Heart function counting ejection fraction (EF) is important in clinical practice because it is connected to prognosis. Whether the patient suffers from valvular heart disease or ischemic heart disease, a measure of heart function including ejection fraction (EF) can calculate future clinical outcome and assist in risk stratification. Several approaches to detect patients at risk for cardiac events have proven to be of value. These contain exercise testing, assessment of exercise capacity, and determination of left ventricular function.

Patients with usual heart function and ejection fraction (EF) generally feel comfortable with exercise activity unless the patient is reconditioned and suffers from being sedentary. Another situation where patients can be suffering from shortness of breath but have a normal ejection fraction is called diastolic heart failure. The patients with this situation generally have a left ventricle with thicker and stiffer walls. The heart holds a smaller amount of blood and cannot meet the body’s needs. This is also called “heart failure with preserved ejection fraction” . Several elderly patients with hypertension and diabetes can be affected by this situation. Below is an MRI study followed by an echocardiogram of a patient with severe left ventricular hypertrophy and normal heart function and ejection fraction.

A borderline heart function and ejection fraction (41-49%) can result from a cardiomyopathy, valvular heart disease or ischemic heart disease (pts with coronary artery blockages). This generally leads to shortness of breath during activity. Below is a patient with coronary disease and critical stenos is of the proximal LAD. There is hypokinesis or reduced contraction in the distal anterior wall and apex

Heart function assessed by measuring left ventricular volumes-

In patients with valvular insufficiency or ischemic heart disease, the enlargement of the left ventricular volume (particularly end-systolic LVESV) can be connected to a poor prognosis. For this reason, serial measurements of left ventricular size and function are used to follow these patients so that surgical intervention can be performed prior to irreversible damage to the heart is done. Similarly, patients recovering from a large myocardial infarction can develop adverse left ventricular remodeling leading to irreversible injure and the development of clinical heart failure.

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