Ejection Fraction Explained: Know Its Normal Range And What It Means For The Heart

Is your heart functioning properly? There is a test which can measure this, which is often recommended by medical professionals. Ejection fraction (EF) is a measurement, expressed as a percentage, of the quantity of blood the left ventricle pumps out with each contraction. This article will not only explore what ejection fraction is, but also its normal range, types and tips to improve it. 

To get a better understanding of this, we reached out to Dr Sandeep Chopra, Director Cardiology, Fortis Hospital Ludhiana and Dr Sanjay Bhat, Sr Consultant – Interventional Cardiology, Aster CMI Hospital, Bangalore.

What Is Ejection Fraction? 

Before understanding how the ejection fraction is linked to the heart, let us tell you what it is. “Ejection Fraction or EF is a key measure of how well the heart is pumping blood to the body. It represents the percentage of blood that is pushed out from the heart’s main pumping chamber with each heartbeat. In general, a higher EF reflects better heart function, while a lower EF indicates reduced pumping efficiency,” shares Dr Chopra.

He adds, “EF is most commonly measured for the left ventricle, which pumps oxygen rich blood to the body. In certain situations, doctors also assess right ventricular EF, which reflects blood flow to the lungs.” On this note, Dr Bhat shares, “If your EF is 60%, it means 60% of the blood in the ventricle is pumped out every time the heart beats, which helps doctors understand how strong or weak the heart is.”

As per the American Heart Association, EF is measured in terms of percentage. An ejection fraction of 60% denotes that 60% of the blood in the left ventricle is pushed out with each heartbeat. 

Tests For Ejection Fraction

The American Heart Association further notes that these tests can help measure ejection fraction:

• Echocardiogram.
• MUGA scan.
• CT scan.
• Cardiac catheterisation.
• Nuclear stress test.

Echocardiogram is the most common test to measure EF. As per the American Heart Association, an echocardiogram makes use of sound waves to create pictures of your heart. The test is also known as echocardiography or diagnostic cardiac ultrasound.

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What Is A Normal Ejection Fraction Range?

Now, let us tell you what the healthy or normal range of EF looks like. Dr Chopra lists it down for you:

In most healthy adults, EF ranges between 50 percent and 70 percent.

• An EF between 40 percent and 49 percent is considered mildly reduced and may cause symptoms during physical activity.
• An EF of below 40 percent usually suggests heart failure with reduced pumping ability and requires closer medical supervision. Its clinical term is HFrEF (Heart Failure with Reduced Ejection Fraction) or systolic heart failure. It indicates the left ventricle is not contracting properly, reducing the amount of oxygen-rich blood pumped to the body.

“Some patients may still develop heart failure despite having a normal EF. This condition is known as heart failure with preserved ejection fraction, where the heart muscle becomes stiff and does not fill adequately,” adds the expert.

What Are The Different Types Of Ejection Fraction? 

As per the Cleveland Clinic, depending on where measurements are taken from, either the left or right ventricle, EF can be of two types:

• Left Ventricular Ejection Fraction (LVEF): Ejection fraction generally refers to the left side of the heart. It indicates how much oxygen-rich blood is pumped out of the left ventricle to most of the body’s organs with each contraction. LVEF helps understand the severity of dysfunction on the left side of the heart.
• Right Ventricular Ejection Fraction (RVEF): This quantifies the amount of oxygen-poor blood pumped out of the right side of the heart to the lungs for oxygen. It is crucial if you have right-sided heart failure. But this condition is uncommon as left-sided heart failure.

Causes, Symptoms And Risk Of Low EF

According to the Cleveland Clinic, healthy muscle tissue is needed for ventricular contractions that pump blood out to the body. When certain conditions weaken or damage the heart muscles, it can make these contractions incomplete or less effective.

That’s when the heart may compensate by working harder. This extra load can lead to swelling or scar tissue buildup which affects the ventricle’s ability to fill and pump. That’s when the heart function declines and your ejection fraction worsens.

It further mentioned that the lower the ejection fraction, the more severe the heart failure symptoms, which include:

• Confusion.
• Fatigue.
• Heart palpitations.
• Nausea.
• Shortness of breath (dyspnea).
• Water retention in abdomen or feet.
• Weakness.

What is the risk of low EF? As per the American Heart Association, an EF from 41% to 49% (considered mildly reduced) It may or may not mean that an individual is developing heart failure; but it may show damage, early cardiomyopathy or risk for heart failure. On the other hand, an EF measurement below 40% usually shows heart failure or cardiomyopathy.

Tips To Improve Ejection Fraction

As per Harvard Health, some of the causes of low EF consists of cardiomyopathy (a disease of the heart muscle with varied causes, such as a viral infection or a genetic disorder); chronic high blood pressure; an abnormally fast heart rate for a long period of time caused by uncontrolled atrial fibrillation may also weaken the heart. But the good news is that one can improve their EF. Our experts share tips for the same. Let’s take a look:

Medications

Taking prescribed medicines regularly like beta-blockers or ACE inhibitors can help improve EF. 

Lifestyle Changes

• Improving EF depends on treating the root cause and making healthy lifestyle changes, such as controlling blood pressure, diabetes, and cholesterol.
• Reducing salt intake, maintaining a healthy weight, doing regular light to moderate exercise as advised by a doctor.
• Avoiding smoking and alcohol.
• Managing stress. 

Monitoring

Going for regular check-ups is important, because with early treatment and consistent care, many people can improve their EF and live a better and more active life.

When To See A Doctor

Individuals who are living with low EF, they need to focus on managing the underlying cause. Dr Chopra shares that an important part of this is consultation with a medical professional – this can help them get the right medications regularly, and keeping their blood pressure and diabetes in control. “Moreover, a low salt diet, healthy weight and doctor guided exercise can also help improve EF in some patients,” adds the expert.

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Conclusion

Ejection Fraction or EF is a key measure of how well the heart is pumping blood to the body. EF ranges between 50 percent and 70 percent in most healthy adults. Improving EF depends on treating the main underlying cause, getting the right medications and making healthy lifestyle changes like controlling blood pressure, diabetes, and cholesterol.