Yes, it is possible to live with an ejection fraction of 20%, but it indicates severely reduced heart function and carries a significant risk of heart failure and other complications. The prognosis and quality of life will depend heavily on the underlying cause of the reduced ejection fraction, the presence of other medical conditions, and the effectiveness of treatment.
Understanding Ejection Fraction
Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. A normal EF is typically between 55% and 70%. An EF of 20% indicates that the heart is only pumping a small fraction of its blood volume with each beat, leading to insufficient blood supply to the body.
Implications of an Ejection Fraction of 20%
Having an EF of 20% usually means:
- Severe Heart Failure: The heart struggles to meet the body's demands for oxygen and nutrients.
- Symptoms: Individuals often experience shortness of breath, fatigue, swelling in the legs and ankles (edema), and dizziness.
- Increased Risk: Higher risk of arrhythmias (irregular heartbeats), sudden cardiac arrest, and other heart-related complications.
Factors Influencing Survival
Survival with an EF of 20% is influenced by:
- Underlying Cause: Conditions like coronary artery disease, dilated cardiomyopathy, or previous heart attacks can damage the heart muscle and reduce EF. Addressing the underlying cause is crucial.
- Treatment: Medical management, including medications (ACE inhibitors, beta-blockers, diuretics), lifestyle changes (diet, exercise), and potentially implantable devices (defibrillators, pacemakers), can improve heart function and survival.
- Overall Health: The presence of other medical conditions, such as diabetes, kidney disease, or lung disease, can affect the prognosis.
- Individual Response: Each person's response to treatment varies. Some individuals may experience improvement in EF with appropriate medical care and lifestyle modifications.
Treatment Options
Treatment for an EF of 20% aims to improve heart function, reduce symptoms, and prevent complications. Common approaches include:
- Medications:
- ACE inhibitors/ARBs: Help relax blood vessels and reduce the heart's workload.
- Beta-blockers: Slow heart rate and lower blood pressure, improving heart function.
- Diuretics: Reduce fluid retention and relieve symptoms of heart failure.
- Aldosterone antagonists: Help reduce fluid retention and protect the heart.
- ARNI (Angiotensin Receptor-Neprilysin Inhibitor): Combination medication that enhances the beneficial neurohormonal pathways and suppresses the harmful ones.
- Lifestyle Modifications:
- Low-sodium diet: Reduces fluid retention.
- Regular exercise: Improves cardiovascular health (under medical supervision).
- Weight management: Reduces strain on the heart.
- Smoking cessation: Improves overall cardiovascular health.
- Implantable Devices:
- Implantable Cardioverter-Defibrillator (ICD): Prevents sudden cardiac arrest by delivering an electrical shock to restore normal heart rhythm.
- Cardiac Resynchronization Therapy (CRT): A special type of pacemaker that helps coordinate the contractions of the heart's ventricles.
- Advanced Therapies:
- Heart Transplant: May be an option for select patients with severe heart failure who don't respond to other treatments.
- Left Ventricular Assist Device (LVAD): A mechanical pump that assists the heart in pumping blood.
Prognosis
While survival is possible with an EF of 20%, it's important to acknowledge the serious nature of the condition. Continuous monitoring, adherence to treatment plans, and regular follow-up with a cardiologist are crucial. The reference states that below 20%, ejection fraction is no longer a good predictor of mortality.
