Treatments and Lifestyle Changes for Low Ejection Fraction

Treatment for low Ejection Fraction (EF) aims to lessen the heart's workload, prevent fluid overload, and help the heart muscle recover or improve its pumping strength (a process known as reverse remodeling).

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Key Medications (Guideline-Directed Medical Therapy)

Cardiologists typically use a combination of core medication classes—often referred to as the "four pillars" of heart failure therapy:

1. ARNI / ACE Inhibitors / ARBs
   • Examples: Sacubitril/valsartan (Entresto), lisinopril, losartan.
   • Role: Relax blood vessels, lower blood pressure, and reduce strain on the heart muscle to slow down or reverse heart enlargement.
2. Beta-Blockers
   • Examples: Metoprolol succinate, carvedilol, bisoprolol.
   • Role: Slow the heart rate, shield the heart from stress hormones (adrenaline), and decrease the risk of dangerous heart rhythms.
3. MRA (Mineralocorticoid Receptor Antagonists)
   • Examples: Spironolactone, eplerenone.
   • Role: Block hormones that cause sodium and water retention, preventing scarring (fibrosis) in heart tissue.
4. SGLT2 Inhibitors
   • Examples: Dapagliflozin (Farxiga), empagliflozin (Jardiance).
   • Role: Originally designed for diabetes, these medications lower hospitalization risks and improve heart function by improving kidney fluid excretion and cellular energy in heart tissue.
5. Diuretics (Water Pills)
   • Examples: Furosemide (Lasix), torsemide.
   • Role: Used as needed to remove excess fluid, reducing swelling in the legs and relieving shortness of breath.

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Medical Devices and Surgical Interventions

If medications alone do not sufficiently restore EF or if underlying structural issues exist, medical procedures may be recommended:

• Implantable Cardioverter-Defibrillator (ICD): A small device implanted under the skin to monitor rhythm and deliver an electric shock if a life-threatening arrhythmia occurs (common with EF ≤ 35%).
• Cardiac Resynchronization Therapy (CRT / Biventricular Pacemaker): Helps both sides of the heart beat in unison to improve pumping efficiency.
• Coronary Revascularization (Stents or CABG): Restores blood supply to the heart muscle if low EF is caused by blocked coronary arteries.
• Valve Repair or Replacement: Fixes leaking or narrow heart valves causing backpressure on the left ventricle.

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Essential Lifestyle Changes

Lifestyle choices directly influence fluid balance and heart workload:

• Sodium Restriction: Limiting sodium intake (typically under 1,500 to 2,000 mg per day) prevents the body from retaining fluid.
• Daily Weight & Fluid Management: Tracking weight daily helps catch fluid retention early (e.g., gaining 2–3 lbs overnight or 5 lbs in a week).
• Supervised Exercise (Cardiac Rehab): Controlled, low-impact aerobic exercise helps improve vascular efficiency without overexerting the heart.
• Avoiding Toxins: Completely stopping tobacco use and avoiding alcohol, which can act as a direct toxin to heart muscle cells (alcoholic cardiomyopathy).
• Managing Related Conditions: Keeping blood pressure, obstructive sleep apnea, and blood sugar levels strictly managed.