Drugs That Improve Cardiac Ejection Fraction
Your heart has 4 chambers: an atrium and a ventricle each on the right and left sides. Between heartbeats, blood flows into the atria. It then passes into the ventricles and is pumped out to the body. The percentage of the blood contained in a ventricle that is pumped out when the heart contracts is the ejection fraction, or EF 2. The EF is a measure of how well the heart is working. Normal EFs are greater than or equal to 50 percent. A heart attack, high blood pressure, abnormal heart rhythms and other diseases can reduce the EF to abnormal levels. There are several strategies for improving EF with medications.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Strengthening the Heart Muscle
Digitalis is one of the oldest drugs still in use, principally administered as a derivative known as digoxin (Lanoxin). Ventricular muscle shortens to force blood out of the heart. Digoxin increases the strength and rapidity of that shortening. It may also help control abnormal heart rhythms that reduce EF. Other drugs similarly increase pumping action, such as milrinone (Primacor) and dobutamine (Dobutrex). These drugs are not routinely recommended for heart failure and are reserved for highly monitored treatment of acute heart failure that's resistant to other therapies.
- Digitalis is one of the oldest drugs still in use, principally administered as a derivative known as digoxin (Lanoxin).
- These drugs are not routinely recommended for heart failure and are reserved for highly monitored treatment of acute heart failure that's resistant to other therapies.
Reducing Blood Vessel Resistance to Flow
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Arteries also have muscles. The more they contract, the smaller the channel through which blood flows and the greater the strain on the heart muscle. Angiotensin, a naturally occurring hormone, is a very potent constrictor of blood vessels. Drugs that inhibit angiotensin formation or block its ability to link to the blood vessel help to relax the vessel muscles and are the foundation of the Heart Failure Society of America guidelines. Examples include captopril (Capoten), enalapril (Vasotec), valsartan (Diovan) and losartan (Cozaar). The heart can eject more blood per beat due to that relaxation, improving EF. A combination of the drugs hydralazine and isosorbide (Bidil) may be effective in patients who are resistant to -- or intolerant of -- the angiotensin inhibitors.
- Arteries also have muscles.
- Angiotensin, a naturally occurring hormone, is a very potent constrictor of blood vessels.
Relaxing the Heart Muscle
In response to decreased EF, the body releases substances such as epinephrine that increase the rate and strength of ventricular contraction. While temporarily effective, chronic elevations of those compounds cause stiffening of the heart muscle and decrease its motion. Beta blockers are drugs that counteract those actions, decreasing the tension in the wall of the heart and improving contraction ability. The three that are recommended are carvedilol (Coreg), metoprolol succinate (Toprol XL) and bisoprolol (Zebeta). Beta blockers are most often used in combination with angiotensin inhibitors.
- In response to decreased EF, the body releases substances such as epinephrine that increase the rate and strength of ventricular contraction.
- Beta blockers are drugs that counteract those actions, decreasing the tension in the wall of the heart and improving contraction ability.
Decreasing Fluid Load
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The kidneys often do not function normally in decreased EF conditions, and excess fluid may be retained. This results in an increased load on the heart. Diuretics increase the elimination of water and salts and are commonly combined with other classes of drugs in treating low EF. Examples are furosemide (Lasix) and spironolactone (Aldactone).
- The kidneys often do not function normally in decreased EF conditions, and excess fluid may be retained.
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References
- Agency for Healthcare Research Quality: National Guideline Clearinghouse -- Heart Failure in Patients With Reduced Ejection Fraction -- HFSA 2010 Comprehensive Heart Failure Practice Guideline
- British Medical Journal: Benefits of β Blockers in Patients With Heart Failure and Reduced Ejection Fraction -- Network Meta-Analysis
- Circulation: Contemporary Reviews in Cardiovascular Medicine
- Schultheiss HP, Fairweather D, Caforio ALP, et al. Dilated cardiomyopathy. Nat Rev Dis Primers. 2019;5(1):32.doi: 10.1038/s41572-019-0084-1
- Fleg JL. Healthy lifestyle and risk of heart failure: An ounce of prevention well worth the effort. Circ Heart Fail. 2016;9(4):e003155. doi: 10.1161/CIRCHEARTFAILURE.116.003155
- Minelli P, Montinari MR. The Mediterranean diet and cardioprotection: historical overview and current research. J Multidiscip Healthc. 2019;12:805-815. doi: 10.2147/JMDH.S219875
- Brown JD, Buscemi J, Milsom V, Malcolm R, O’Neil PM. Effects on cardiovascular risk factors of weight losses limited to 5-10. Transl Behav Med. 2016;6(3):339-346..doi: 10.1007/s13142-015-0353-9
- American Heart Association. Prevention and treatment of cardiomyopathy. Updated March 31, 2016.
- American Heart Association. Physical exercise recommendations. Updated April 18, 2018.
- Cleveland Clinic. Cardiomyopathy, diagnosis and treatment. Updated April 29, 2019.
- John Hopkins Medicine. Congestive heart failure: prevention, treatment and research.
- Xiang Y, Shi W, Li Z, et al. Efficacy and safety of spironolactone in the heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction: A meta-analysis of randomized clinical trials. Medicine (Baltimore). 2019;98(13):e14967. doi:10.1097/MD.0000000000014967
- Al-mohammad A. Hydralazine and nitrates in the treatment of heart failure with reduced ejection fraction. ESC Heart Fail. 2019;6(4):878-883. doi: 10.1002/ehf2.12459
- Tariq S, Aronow WS. Use of Inotropic Agents in Treatment of Systolic Heart Failure. Int J Mol Sci. 2015;16(12):29060-8.doi: 10.3390/ijms161226147
- Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. J Am Coll Cardiol 2018:15(10);E190-E252. doi:10.1016/j.hrthm.2017.10.035
- Tehzeeb J, Manzoor A, Ahmed MM. Is stem cell therapy an answer to heart failure: A Literature search. Cureus. 2019;11(10):e5959. doi:10.7759/cureus.5959
- Kieserman JM, Myers VD, Dubey P, Cheung JY, Feldman AM. Current landscape of heart failure gene therapy. J Am Heart Assoc. 2019;8(10):e012239. doi: 10.1161/JAHA.119.012239.
- Cleveland Clinic. Heart Disease and Stem Cell Therapy. Updated Jan. 3, 2019.
- Food and Drug Administration.FDA warns about stem cell therapies. Sept. 3, 2019.
- Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: Executive summary. Circulation. 2013;128:1810–1852. doi:10.1161/CIR.0b013e31829e31829e8807
Writer Bio
C. Richard Patterson is a retired surgeon and chief medical officer with special interest and experience in gastrointestinal, breast, cancer and trauma surgery. He is the author or co-author of 17 scientific publications, including textbook chapters.