how do i increase EF

[gaurangmin]

sir my dad had bye pass done 1 1/2 year back after that he had 3 heart failure doctor says his EF has to inprove from resent 30% sir can u please guide me to measure to be taken to inprove EF. i really need help 2ndly i an in india please guide me to medicinse which are available in india.

[kenkeith]

Insurance underwriters usually accepts below 30% as heart failure as does social security claims. I always considered the >30% to be a little high as there are many individuals that function well with an EF in the 20's?!

When I went to the ER having had a silent heart attack and then CHF my EF according to a cath was about 13% and an echo calculated it to be 24%.  I walked into the ER and the only symptoms I had was slight shortness of breath and a dry cough. I was shocked to hear I hear had a bad heart!  Then one can read there are people with aEF in the 50's and know they have a heart problem by the symptoms.  Probably gets down to how well one's system comnpensates for a weaker than normal heart.

Good to see you are back...hope everything went as well as expected for you.  Take care.

[ed34]

There seems to be some misconception among some people that the only way to increase EF is to exercise, which is generally true for healthy hearts. However, in the UK, anything below 35% it termed as CHF and it has been found that rest is the best way to improve matters. If the EF doesn't improve and starts to worsen, then assist pumps can be used to help rest the heart. These were used in the UK solely for keeping a patient alive until a suitable donor could be found for transplant, but it was seen quite a number of patients were actually improving with these and could eventually have the pump removed, and be taken off the transplant list. More research is being done in London to try and understand how this works but it appears if given enough rest the heart has quite a good ability to recover.
As Kenkeith points out, medication is vital and a great aid to improvements.

[kenkeith]

To increase the heart's ejection fraction may depend on the underlying cause. If there is heart muscle necrosis (dead heart cells) the ability of the heart wall to contract may be irreversible. If the contractility is associated with an enlarged heart, sometimes the EF can be improved by reducing the left ventricals size.  

Regardless, the EF also depends on the "load" on the heart.  There is preload and that is the amount of blood that fills the left ventricle during the resting phase and expands the heart wall chamber. An expanded chamber nomally increases the EF by the Frank/Starling mechanism...an anology would be a handspring that is stretched will spring back with more force, and over stretch is will become flaccid.  When the heart is over stretched (dilated it will lose its contractility) and that will decrease the EF to a level below 29% (heart failure range).  Reduce the heart's workload can return the heart size to normal and the EF will return to normal.  That happened in my heart failure experience.

To help reduce the heart's size (dilated) from overwork, the afterload (resistence the heart pumps against) can be treated.  The medication is an ACE inhibitor (lisinopril), and a beta blocker (coreg).  This medication will provide relief to heart's workload and is some cases the heart will return to normal and increase the EF.  

•Inotropes (such as digoxin):
Helps the heart to contract more vigorously and effectively, and helps to reduce symptoms.
•Angiotensin II receptor blockers:
Similar to ACE inhibitors, these medications reduce the stress on the heart muscle and may benefit patients with diabetes and heart disease. The medication apparently protects the kidneys from the diabetes-related complications.
•Betablockers:
These medications may improve symptoms by slowing the heart's contraction rate and reducing its pumping action, thus lessening the heart's workload.

Hope this gives you a perspective. Thanks for your question and if you any further questions or comments you are invited to respond.  take care.

Ken