Systolic congestive heart failure, or systolic heart failure, is a type of heart failure that involves the left side of the heart. As the left side of the heart begins losing some function, it loses its ability to contract properly. Poor contraction causes the heart to not pump with enough force for blood to circulate properly.
According to the latest data statistics, systolic heart failure happens when the heart pumps at 40% or less of its ejection fraction. Ejection fraction measures how much blood the heart pumps with each contraction or beat. Systolic heart failure is also referred to as heart failure with reduced ejection fraction, or HFrEF.
Roughly 6.5 million people in the United States have heart failure of some type, and an estimated half of these cases are HFrEF. The risk of developing systolic heart failure can increase with age.
Systolic Congestive Heart Failure Symptoms
Heart failure symptoms can sometimes begin suddenly, but symptoms usually develop slowly. In the early stages of systolic heart failure, symptoms may occur only when physically active. Over time, you may notice symptoms even at rest.
A person with systolic heart failure may have the following symptoms: Increased heart rate; Heart palpitations (sensations like your heart is racing); Shortness of breath, especially at night or while lying down; Wheezing; A cough that won’t go away; Weight gain; Expansion of the stomach area due to fluid buildup; Leg swelling; Swelling of the scrotum; Bulging of major neck veins (also called jugular vein distention); Loss of appetite; Confusion.
What Causes Systolic Congestive Heart Failure?
In systolic heart failure, the left ventricle (the heart’s left lower chamber) becomes larger and weakens over time. The more common causes of this enlargement are coronary artery disease and high blood pressure (hypertension).
Coronary artery disease occurs when the arteries that bring blood and oxygen to your heart become narrow or blocked. If your blood pressure is high for too long, your heart has to work harder, making the heart muscle stiff or weak over time.
Other heart-related issues that can lead to heart failure include: Structural difference in the heart present at birth: Some people are born with heart problems known as congenital heart disease that can lead to heart failure later in life. Heart attack: A heart attack happens when a sudden blockage in a heart artery stops blood flow, damaging the heart muscle. Heart valve problems: If the valves in your heart don’t open and close properly, blood flow is affected, which can negatively affect the heart. Infections: Certain infections (e.g., viruses that cause COVID-19 or the flu) can damage the heart muscle and weaken it. Irregular heart rhythms: Medically known as arrhythmia, irregular heartbeats can sometimes cause the heart to work less effectively, potentially leading to heart failure.
Many conditions unrelated to the heart can also hurt the muscle and contribute to heart failure. These conditions include: Type 2 diabetes: This is a condition where the body either doesn’t produce enough insulin or doesn’t use the hormone effectively. Over time, uncontrolled blood sugar levels can damage the blood vessels that feed the heart. Metabolic syndrome: This includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Together, these conditions increase the risk of heart disease, stroke, and type 2 diabetes. Overactive thyroid (hyperthyroidism): This condition involves the thyroid gland producing too much thyroid hormone. An overactive thyroid can speed up heart rate and cause irregular heart rhythms.
Risk factors for systolic heart failure include having a history of smoking, misusing alcohol or drugs, and being overweight or obese.
Diagnosis
Healthcare providers can diagnose systolic congestive heart failure using your medical history, performing a physical exam, and running some tests. These tests may include:
Electrocardiogram (ECG or EKG): This measures the electrical activity as the heart beats. It may show conditions that can lead to heart failure, like an irregular heart rhythm or a heart attack. Chest X-ray: This scan shows the heart and surrounding blood vessels in the chest. It can indicate if there is fluid in your lungs, which is a potential sign of heart failure. Echocardiogram: This imaging uses ultrasound waves to view the size, structure, and function of the heart’s chambers and valves. This test also measures the ejection fraction. Exercise test (stress test): An exercise test looks at how well the heart performs during exercise. It also looks for blockages or narrowing of arteries that affect the blood supply to your heart. Left heart catheterization: This procedure helps measure how well your heart is functioning. It provides pictures of the coronary arteries to look for blockages.
Blood tests can also help diagnose systolic heart failure, such as the blood test for B-type natriuretic peptide (BNP), a hormone made by the heart. In people with heart failure, BNP levels are often higher than normal. Other imaging tests, like computed tomography (CT), magnetic resonance imaging (MRI), and nuclear scanning, may also help diagnose heart failure.
Treatments for Systolic Congestive Heart Failure
Your healthcare provider and various specialists, like a cardiologist (a doctor who specializes in diagnosing and managing heart conditions), will work to treat both the symptoms and the cause of systolic heart failure. They will likely recommend some combination of the following:
Medications
Most people with heart failure take angiotensin-converting enzyme (ACE) inhibitors or a similar type of medication.
ACE inhibitors are oral medications that can keep heart failure from worsening by relaxing blood vessels, lowering high blood pressure, and allowing the heart to pump blood more efficiently. ACE inhibitors decrease your body’s production of angiotensin-2, a hormone that regulates blood pressure and body fluid.
Angiotensin receptor blockers (ARBs) are a medication with the same goals as ACE inhibitors: relaxing blood vessels and lowering blood pressure. Rather than decreasing the production of the angiotensin-2 hormone the way ACE inhibitors do, ARBs block the hormone from being able to narrow blood vessels.
There are several other medications providers might prescribe to someone with heart failure, including:
- Beta-blockers: These medications slow your heart rate, allowing the heart to pump blood more effectively to prevent heart failure from worsening.
- Diuretics: Also known as water pills, these medications help remove excess salt and fluid from your body.
- Sodium-glucose cotransporter-2 (SGLT2) inhibitors: These oral tablets reduce the risk of death and hospitalization due to HFrEF.
Devices
Providers may suggest device implantation for some people. These devices go into the body to help the heart function.
One device is the implantable cardioverter-defibrillator (ICD). An ICD is implanted under the skin (usually near the collarbone) to monitor heart rhythms. It delivers shocks if a dangerous rhythm is detected.
Ventricular assist devices (VADs) are mechanical pumps that support heart function in patients with severe heart failure. VAD implantation is usually reserved for people waiting for a transplant or as long-term therapy if a transplant isn’t possible.
Surgeries
Sometimes, surgery might be necessary.
Coronary revascularization is a procedure that restores blood flow to the heart in patients with blocked arteries and heart failure. It is often completed through bypass surgery, which creates alternate pathways for blood flow to the heart.
In cases of severe heart failure, surgeons may need to replace the failing heart with a healthy donor heart through heart transplantation.
Lifestyle Changes
Changing how you eat, adopting new habits, or getting rid of old habits may help treat systolic heart failure. A healthcare provider may recommend any of the following:
- Reduce salt intake: Too much salt can lead to fluid buildup and worsen your symptoms.
- Manage your weight: Reaching and maintaining the ideal weight (determined by you and your healthcare provider) can reduce stress on the heart.
- Stay active: Regular physical activity can reduce some factors that worsen heart failure, including high blood pressure.
- Avoid smoking: Smoking can further damage your heart over time.
- Limit alcohol: Alcohol can negatively affect heart health, so your provider may recommend reducing or stopping your intake.
- Reduce stress: Stress management techniques like relaxation exercises, counseling, and support groups can improve physical health.
- Get adequate sleep: Sleeping for 7-9 hours each night is recommended for maintaining a healthy heart. Addressing sleep disorders like sleep apnea can also improve your heart health.
Prevention
There are several steps you can take to reduce the likelihood of developing systolic heart failure. These include:
- Adopt a heart-healthy diet: Eat a balanced diet low in salt, saturated fats, and sugars and rich in fruits, vegetables, and whole grains.
- Exercise regularly: Get at least 30 minutes of moderate-intensity physical activity daily, such as brisk walking, cycling, and dancing.
- Manage your stress: Find activities that lower your stress and do them regularly. Take a yoga class, relax with friends, or try a new activity.
- Avoid smoking: Smoking can increase your risk of heart disease, especially if you have other risk factors like high cholesterol or high blood pressure.
Get regular checkups to monitor blood pressure, cholesterol, and blood sugar levels. Early detection and management of these risk factors can prevent heart failure from developing.
Related Conditions
You might be more likely to have or develop certain conditions if you have systolic heart failure. These conditions include:
- Chronic obstructive pulmonary disease (COPD): This lung condition makes breathing hard due to damage and inflammation of the airways. While their causes are different, COPD and heart failure are frequently associated. The two conditions also share symptoms, including shortness of breath.
- Liver damage: Heart failure can lead to fluid buildup and reduced blood flow to your organs, including your liver. This can lead to liver thorough cirrhosis (scarring of the liver).
- Kidney damage: The kidneys depend on the heart for proper blood flow and pressure. With heart failure, the kidneys don’t have as much blood flow, leading to damage.
- Other heart conditions: Heart failure can lead to conditions like pulmonary hypertension, irregular heartbeat, heart valve disease, and sudden cardiac arrest.
Living With Systolic Congestive Heart Failure
Systolic congestive heart failure can impact your life in various ways. Medication and lifestyle changes can often control heart failure. The condition could also suddenly worsen for a few reasons, including if you develop an infection, eat a diet high in salt, or have a heart attack.
Life expectancy with HFrEF depends on the condition’s severity and your overall health. Compared to other types of heart failure, HFrEF has a worse prognosis and higher mortality rate. An important factor in the prognosis is how your ejection fraction changes over time, so monitoring and managing your systolic heart failure is key.
