Systolic Heart Failure

Systolic heart failure, also called heart failure with reduced ejection fraction, occurs when your left ventricle can’t pump blood efficiently. It’s a serious condition and can cause damage to other organs. Treatment addresses any underlying causes, such as coronary artery disease or hypertension, along with lifestyle changes.


What is systolic heart failure?

Systolic heart failure is a condition in which the left ventricle of your heart is weak.

Your left ventricle is the largest and strongest chamber of your heart. It’s responsible for pumping oxygen-rich blood from your lungs to the rest of your body.

When the left ventricle is weak it can cause fluid to build up in your lungs, resulting in shortness of breath or fatigue. It can also cause swelling in your body, including your belly, feet and legs.

Systolic heart failure can result from coronary artery disease, high blood pressure, previous heart attack, abnormal heart rhythm, alcohol use disorder and many other causes.

It’s important to recognize symptoms of heart failure and identify the cause. There are many treatments available that can improve your heart function, quality of life and how long you live.


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What is ejection fraction?

Systolic heart failure is also called heart failure with reduced ejection fraction (HFrEF).

Ejection fraction (EF) is a measurement that represents the percentage of blood the left ventricle pumps out with every contraction. It’s a sign of how well your heart is pumping blood.

The normal, healthy range for EF measurement is 55% to 70%. An EF under 40% may indicate systolic heart failure.

Who might get systolic heart failure?

Anyone can develop systolic heart failure, but it’s more common as people age. It typically occurs in people who have had another heart-related condition.


Symptoms and Causes

What causes heart failure with reduced ejection fraction?

Systolic heart failure can develop when another condition damages the left ventricle, such as:

The damage can create a scar in your heart muscle, stretch the ventricle or make it stiff. These effects will weaken the ventricle and reduce the ejection fraction. Often, addressing the causes of heart failure can improve heart function.

What are the symptoms of systolic heart failure?

Signs of systolic heart failure may include:

  • Chest pain.
  • Coughing or wheezing that won’t go away.
  • Fatigue, weakness or dizziness.
  • Nausea or lack of appetite.
  • Rapid or irregular heartbeat.
  • Shortness of breath (dyspnea) with exertion or lying flat.
  • Swelling in the belly, feet or legs.


Diagnosis and Tests

How is systolic heart failure diagnosed?

To diagnose systolic heart failure, your healthcare provider will use several strategies. It’s essential to determine any underlying causes so they can be treated.

Diagnosis usually includes:

  • Physical exam.
  • Blood work.
  • Images of the heart.
  • Ejection fraction tests.

During a physical exam, the healthcare provider will:

  • Ask you about your symptoms and how long they’ve been happening.
  • Ask you about your medical history, including previous heart-related conditions.
  • Listen to your heart and lungs.
  • Take your blood pressure.
  • Weigh you.

Your healthcare provider may order blood work. The results can show if heart failure is causing a strain on other organs. Blood work may include measurements of:

  • Albumin (a kind of protein).
  • Creatinine (related to kidney function).
  • Sodium.
  • Potassium (electrolytes).

Diagnostic imaging tests can help the healthcare team see the heart and any structural problems:

Tests to measure ejection fraction include:

Your healthcare provider may also do an electrocardiogram (EKG) to test your heart’s rate and rhythm.

Management and Treatment

How is systolic heart failure treated?

The first goal of treatment for HFrEF is to treat any underlying causes. For example, if you have hypertension, you may need drugs to manage your blood pressure. If you have diabetes, you should take medications to control blood sugar. Some patients may need surgery or an implanted device to help the heart function.

Your healthcare provider may also recommend some lifestyle changes to help manage underlying conditions and keep your heart as healthy as possible:

  • Avoid alcohol, smoking and illegal drugs.
  • Exercise regularly. Start slowly, and always warm-up and cool down.
  • Limit salt intake. Most patients with heart failure should consume no more than 1,500 mg of sodium per day.
  • Maintain a healthy weight. Track your weight, and report any sudden increases to your healthcare provider.
  • Participate in a cardiac rehab program.
  • Reduce stress and get plenty of rest.

What medications are used to treat systolic heart failure?

If you have systolic heart failure, a combination of certain medications can improve your ejection fraction, symptoms and overall heart function. The idea is to reduce stress hormones in your body, and reduce the work your heart needs to do by opening up blood vessels, controlling your heart rate and lowering blood pressure. The medications below will perform each of these tasks:

  • Beta-blockers: This class of medication improves heart function by slowing your heart rate and decreasing the work done by your heart. They may also control blood pressure, reduce the chance of a heart attack, regulate abnormal heart rhythm and block stress hormones.
  • Angiotensin-converting enzyme (ACE) inhibitors: These medications improve heart function over time by controlling blood pressure, opening up blood vessels and blocking stress hormones in your body
  • Angiotensin-receptor blockers (ARBs): These medications work in a similar way as ACE inhibitors, and are given if patients experience side effects from ACE inhibitors.
  • Angiotensin receptor-neprilysin inhibitors (ARNIs): This class of medication can also improve heart function by decreasing stress hormones, opening blood vessels and decreasing stress hormones in your body.
  • Aldosterone antagonists: These medications can improve heart function by reducing stress hormones in your body and helping your kidneys remove extra fluid from your body.
  • Diuretics (water pills): These pills improve symptoms of heart failure by helping your kidneys remove extra fluid. Reducing fluid helps your heart pump more efficiently, reduces swelling and may improve breathing if there’s fluid buildup in your lungs.
  • SGLT-2 inhibitors: This is a class of medication prescribed for people with diabetes. It lowers blood sugar by releasing sugar in your pee. It can also be helpful for people with heart failure as it removes extra fluid from your body.


How can I reduce my risk of systolic heart failure?

You can reduce the chance of getting heart failure by taking good care of yourself:

  • Eat a well-balanced, nutritious diet.
  • Exercise regularly.
  • Get enough rest.
  • Limit or eliminate unhealthy things such as alcohol, illegal drugs, smoking and foods high in fat or salt.
  • Maintain a weight that’s healthy for you.
  • Reduce stress.

Outlook / Prognosis

What is the outlook for people with systolic heart failure?

Heart failure is a chronic (lifelong) serious condition that can shorten your lifespan. Prognosis depends on several factors, including:

  • How advanced heart disease is.
  • Overall health and other health conditions.
  • Response to treatments.
  • Underlying cause.

Living With

When should I seek medical attention?

Seek medical attention immediately if you experience:

  • Chest pain.
  • Fainting or extreme weakness.
  • Rapid or irregular heartbeat.
  • Sudden and severe shortness of breath.

What else can I ask my healthcare provider?

Consider asking your healthcare provider:

  • What is causing systolic heart failure?
  • Is it affecting other organs?
  • What is my ejection fraction?
  • How can I improve my condition?
  • What lifestyle changes or medications might help me?
  • What should I avoid?
  • When should we test my ejection fraction again?

A note from Cleveland Clinic

Systolic heart failure is a serious, chronic condition that occurs when the left ventricle can’t pump blood efficiently. Talk to your healthcare provider if you have symptoms of heart failure. Treatment for any underlying causes and good lifestyle choices can ease symptoms and help you live a longer, fuller life.

Medically Reviewed

Last reviewed on 06/14/2022.

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