Treatment Options for Low Ejection Fraction

It is important to note that low ejection fractions caused by conditions such as heart failure or cardiomyopathy are rarely cured. Treatment is therefore focused on reducing symptoms and preventing the progress of the disease involved from worsening. These strategies include lifestyle
changes, medications and procedures, such as the insertion of an implantable defibrillator (ICD).

Recommended Lifestyle Choices

• Limiting physical activity until the appropriate level of activity is approved by one's physician, and then staying as active as possible. Regular aerobic exercise may be recommended, while patients may be instructed to avoid weight training or lifting heavy objects.


• Scheduling relaxation and rest periods throughout the day.


• Eating a heart-healthy diet and avoiding excessive fluid intake.


• Completely avoiding alcohol and/or tobacco use.


• Keeping a daily weight diary and notifying a physician of any weight gain of three or more pounds in a single week (which may indicate fluid retention and the need for an immediate change in treatment).

Medication Intervention

Certain medications help reduce the heart's workload, increase blood flow, widen vessels or eliminate excess water from the body, all which may help treating low ejection fraction. Prescribed medications may include:

• 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.

Procedural Intervention

Depending upon the cause of the depressed ejection fraction, certain procedures may be recommended, such as the insertion of one of the following:

Implantable Defibrillator (ICD):
This implanted device monitors for and, if necessary, corrects an abnormal heart rhythm by sending electrical charges to the heart. An ICD may benefit patients who have experienced serious episodes of fainting (syncope) or arrhythmias associated with a low ejection fraction. ICDs may also be built in to biventricular pacemakers.

This combined type of therapy may benefit heart failure patients who are also at high risk of sudden cardiac death due to some types of abnormal heart rhythms arrhythmias.

In select patients, biventricular pacemakers have appeared to improve ejection fraction and exercise tolerance.

Ventricular Assist Devices (VADs):
An implanted device that helps one of the heart's lower chambers (ventricles) to pump blood. These are used primarily as a "bridge to transplant," meaning that they help patients with low ejection fractions while they await a heart transplant.

Gene Therapy

A promising treatmant being developed for depressed ejection fraction is gene therapy. Researchers continue to explore the nature of stem cells in the treatment of many diseases. Stem cells are immature cells, meaning they have the ability to develop into a variety of mature cells, such as red or white blood cells, platelets, heart muscle cells, brain cells, etc. For example, recent studies have reported encouraging findings after transplanting stem cells taken from patients' own bone marrow into heart muscle following a heart attack.

For heart failure patients, bone marrow cells have been injected into the heart's left ventricle. Other studies have shown promising results in the use of muscle cells taken from other parts of the body (e.g., thigh) and injecting them into damaged areas of the heart. It is believed that such skeletal muscle helps to restore the contractile properties of affected heart muscle, thus improving ejection fraction. However, these treatments are still experimental and have not been approved by the FDA.

Conditions that cause the heart muscle to stiffen may also cause heart failure without producing an abnormal ejection fraction. These conditions include cardiomyopathy in which the heart muscle becomes abnormally enlarged, thickened and/or stiffened. Other causes of heart stiffening include invasion of the heart muscle by foreign sobstances or fibrous tissues.

Identifying the Best Treatment Options and Low Ejection Fraction Specialist for You

Our commitment at CPMC is to help each patient identify the best doctor for their diagnosis and course of treatment. To find the best specialist for Low Ejection Fraction , we want to empower our patients to participate in their health care journey. This means encouraging a frank discussion with the doctor about Low Ejection Fraction, to identify all appropriate treatment options as well as to discuss symptoms, issues, outcomes, etc., when relevant for Low Ejection Fraction. The first step of your journey is research - using online tools such as CPMC's to investigate and understand Low Ejection Fraction. The second step is to schedule an initial consultation with a physician or specialist. In some cases, you'll need to go through your primary care physician if you do not have a referral. If you already have a referral,you can schedule an appointment directly with the Low Ejection Fraction specialist. The third step is for the specialist in Low Ejection Fraction to meet with you and review your history. As part of the diagnosis, you may need testing, so the doctor (surgeon or specialist) can discuss your treatment options and the both of you can determine your best course of action. We have patients at CPMC coming from throughout the San Francisco Bay Area, Northern California, and many from throughout the United States with respect to Low Ejection Fraction. Whether you are from San Francisco, Marin, the San Francisco Bay Area generally or any other location, our physicians will provide the hands-on care you deserve.

California Pacific's Heart and Vascular Center

California Pacific's Heart and Vascular Center is supported by one of the best heart hospital/center networks in the USA, offering quality, comprehensive patient-centered cardiovascular care by a team of top heart surgeons and physicians with leading-edge technology. Serving the entire San Francisco Bay Area, including San Francisco and Marin County, as well as the entire Northern California region, our team has many of the best cardiovascular surgeons and physicians in California and the United States.