Heart failure, a condition where the heart struggles to pump blood efficiently to meet the body’s needs, comes in various forms and one of them, heart failure with preserved ejection fraction (HFpEF), presents an intriguing paradox—a normal or mildly reduced ejection fraction coexisting with heart failure symptoms. To know more about this health condition, we got an expert on board to delve into the realm of heart failure despite a normal ejection fraction and its profound implications.
Understanding Ejection Fraction:
In an interview with HT Lifestyle, Dr Rajiv Kovil, Diabetologist, Chairperson at Zandra Healthcare, Co-Founder of Rang De Neela initiative and Secretary at United Diabetes Forum, explained, “Ejection fraction (EF) quantifies how effectively the heart operates and is expressed as a percentage. It calculates the blood pumped out of the heart’s ventricles with each beat relative to the total blood within those chambers. Typically, a normal ejection fraction ranges between 50% to 70%.”
He added, “Traditionally, ejection fraction has been a cornerstone in diagnosing heart failure. A reduced ejection fraction often signals heart muscle damage, like that resulting from a heart attack, while a normal ejection fraction suggests sound cardiac function.”
Heart Failure with Preserved Ejection Fraction (HFpEF):
Dr Rajiv Kovil said, “HFpEF stands as a unique subtype of heart failure, characterized by heart failure symptoms despite a normal or mildly reduced ejection fraction. Remarkably, HFpEF accounts for nearly half of all heart failure cases and is increasingly prevalent, particularly among older individuals and women.”
He revealed, “Although the precise cause of HFpEF remains partially veiled, it is linked to heart muscle stiffening and compromised relaxation during diastole—the heart’s resting phase. This hinders proper blood filling and leads to fluid retention, culminating in heart failure symptoms like breathlessness, fatigue, and swollen extremities.”
Heart Failure Despite Normal Ejection Fraction:
According to Dr Rajiv Kovil, while a normal ejection fraction is commonly associated with healthy cardiac function, it does not offer an absolute diagnosis for heart failure. He shared, “In certain instances, individuals may grapple with heart failure symptoms despite maintaining a normal ejection fraction. This discrepancy arises because ejection fraction alone fails to consider other contributory factors to heart failure. These may encompass diastolic dysfunction—a heart’s inability to relax and fill adequately during rest. Additionally, conditions such as left ventricular hypertrophy, atrial fibrillation, or pulmonary hypertension can fuel heart failure despite an intact ejection fraction.”
Implications:
Dr Rajiv Kovil highlighted, “Diagnosing and managing heart failure with normal ejection fraction pose a conundrum, demanding additional tests and a comprehensive evaluation of an individual’s clinical presentation and medical history. Diagnostic tools like echocardiograms and cardiac MRI serve as crucial allies, capable of detecting structural anomalies or functional alterations that may underlie heart failure, even in the presence of a normal ejection fraction. In essence, the enigma of heart failure with normal ejection fraction challenges traditional diagnostic boundaries and underscores the importance of a holistic approach to heart health assessment and management.”
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