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Why choose EF?Experience the exciting world of EF!Great destinations and amazing offers!Learn French where it's spoken!Learn about the Incas Culture while studying Spanish in Ecuador!EF can help you to arrange your language course, flights,...EF Internships Abroad, put your language skills to work!What Exactly Is EF, Anyway?What Exactly Is EF, Anyway?Your heart circulates blood through 2 separate systems.The blood returns to the right atrium, which passes it down to the right ventricle.That means your heart muscle is too weak to force as much blood out on each contraction as it should.Now, if your EF sounds bad, don't despair.My EF is now much improved.It is called RVEF and is normally lower than LVEF.Most CHFers will deal mainly with LVEF, or Left Ventricular Ejection Fraction.Around here, that's what we mean by EF.Wave Alternans, very low Vo2max, etc,...However, EF is not a predictor of death.So, don't let a low EF panic you!The left ventricle fills up with blood.Most CHFers have systolic heart failure.That means the heart's left ventricle doesn't pump enough blood out into the body on each beat.You wind up with many of the same problems and many of the same drugs are used to treat both diastolic and systolic heart failure.You can read about diastolic heart failure here.One catch to all this is that you can have a terrible case of DHF and still have a normal EF.So you see that a normal EF doesn't always mean you don't have heart failure.If you have systolic heart failure (SHF), your EF is probably reduced.However, a fairly good EF does not always mean a healthy heart, even in SHF!There are just too many factors at play in a person's body who has heart failure to assume much.As you can see, ejection fraction is not a very good way to define heart failure because there are too many ways EF can seem good even in a person with real nasty heart failure.It varies from minute to minute, hour to hour, and day to day.That makes measuring it less important and our actual EF number less important as well.What is important is the trend of our EF.You can spot the trend of your EF by having it measured once every so often: every 6 months or every year for a couple of years after diagnosis; less if you are stable; more if you are not.Watch the number to see if it goes up or down over time.The number itself is less important.EF and not enough to how we feel day in and day out.In short, how you feel is waaaay more important than what your EF is.EF is important, but by no means something to get obsessed with.Although he has recently acquired additional responsibilities at his medical center, he takes time to answer our questions.Keep in mind that I edit to keep medspeak under control on my pages.After meds took the extra fluid off me and reduced my heart rate, I felt really good.EF went up, my energy level and my quality of life went down.Why does someone with systolic CHF often see a rise in EF over time but they can't do as much as easily as when their numbers were low?Why do I feel worse even though my EF is better?Remember that EF is not a true measure of the heart's ability to contract.If you lower blood pressure and reduce the effects of remodeling, you reduce afterload.So your heart failure meds increase your EF without actually increasing your heart's ability to pump more blood.This may in part explain why your EF can go up but you feel just as bad as ever.EF more than your ability to function.Both drugs act on blood pressure at rest and during exertion.It is very common in CHFers for blood pressure and heart rate to not rise properly during exertion.This may cause fatigue since the skeletal muscles aren't getting a big enough increase in blood supply during exertion.In other words, we prefer to preserve the heart muscle itself rather than work it too hard to improve how other muscles function.These changes reduce your ability to function physically.Rehab (physical conditioning) may partly reverse them, though.Another reason you may feel worse with an improved EF is that you do less exercise and daily activities.Over time, your muscles lose tone.That makes them less able to effectively use the oxygen and nutrients they do get from your heart, and less able to rid themselves of fatigue poisons.You may gain weight from being inactive, which contributes to fatigue as well.This article is by a CHF doc you may know as Gino.The definition of EF on this page is very good, so I'll pass over the definition and methods used to measure it and I will go directly to the heart of the problem.EF is a rough measure of heart function.CHF may be caused by a problem in either one of these phases or in both.EF is a measure of the emptying phase, so your ejection fraction may be normal if your CHF is caused by problems with the heart's filling phase.Since ischemia slows blood flow to the heart, it takes your left ventricle longer to fill.When you exercise, your heart beats faster, which gives your heart even less time to fill per cycle.This high atrial pressure is transmitted backward to the lungs, causing congestion of the lungs.That messes up breathing and causes shortness of breath.There are several other illnesses like HCM that may cause heart failure with a normal EF.There are also conditions where the heart muscle is invaded by foreign substances or where lots of fibrous tissue causes problems.EF is a rough measure of ventricular function but it tells nothing about where the blood goes!So in the case of valve problems, your heart is not functioning well because blood constantly flows back into the atrium.You may have a normal EF but not a healthy heart.EF is usually measured at rest.The same thing may happen with mitral valve insufficiency, due to high pressure in the heart's upper chambers (atriums).Many CHFers have lung problems that play a role in their difficulty during exertion.The same thing is true for being overweight.Anemia may play a role in reduced ability to perform effort, and severe anemia can cause heart failure even though you have high cardiac output.Recent advances in understanding heart failure show that the muscles and their blood vessels also become less functional, regardless of ejection fraction.This may be reversed or stopped by a regular, correct exercise program.Finally, depression and anxiety may be relevant factors on a CHFer's perception of shortness of breath and ability to perform effort, regardless of EF.Updated February 28, 2004
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