Low Ejection Fraction (Low EF)

What is Low Heart Ejection Fraction?

A low ejection fraction (or low EF) is typically 45 or less and can be evidence of heart failure or cardiomyopathy (a disease of the heart muscle). The heart’s ejection fraction (EF) refers to the amount – or percentage – of blood pumped (or ejected) out of the heart’s left ventricle with each contraction. The EF is an important measurement that physicians use to determine how well your heart is pumping out blood and to diagnose or track heart failure.

A normal range for heart ejection fraction may be between 50 and 70. 

Baptist Health is known for advanced, superior care for patients with heart problems and the diagnosis, treatment and management of a low ejection fraction. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

What Happens if Your Ejection Fraction is Low?

If your ejection fraction is low, below 50%, your heart is no longer efficiently pumping blood to meet your body's needs.

Signs and Symptoms

More than one of the following low EF symptoms, particularly if a known heart condition is present, should prompt a physician’s visit:

  • Exercise intolerance
  • Fatigue and weakness
  • Feeling bloated or full
  • Heart palpitations
  • Loss of appetite
  • Mental confusion
  • Nausea
  • Rapid, forceful or irregular heartbeat
  • Shortness of breath
  • Swelling, especially in the feet and lower legs


If you have a heart condition, measuring your ejection fraction can help you and your physician monitor its severity, determine your best course of treatment and check how well a treatment is working. Diagnostic tests for low EF include:

  • Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.
  • Magnetic resonance imaging (MRI):A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.
  • Nuclear heart scan: This safe scan reveals how efficiently blood is flowing through your heart. A small amount of radioactive material is injected into a vein and flows to the heart. It releases energy that allows special cameras to capture pictures of the coronary arteries and heart function.

Decreased ejection fraction doesn’t have many preventable causes. However, it can be triggered by a heart attack, coronary artery disease, diabetes and/or uncontrolled high blood pressure, which can be caused or worsened by: 

  • Alcohol or drug abuse
  • An unhealthy diet, high in saturated fat, sugar and salt
  • Lack of exercise
  • Not taking prescribed medications to control existing conditions
  • Obesity
  • Smoking

Risk Factors

Risk factors that could contribute to low ejection fraction include:

  • Congenital or familial heart valve disease or cardiomyopathy: Some people are born with, or develop inherited forms of, malformed or dysfunctional heart valves or weakening of the heart muscle.
  • Heart attack: A heart attack can damage the heart’s ability to pump blood effectively.
  • Heart failure: If you’ve been diagnosed with heart failure, an inability for the heart to pump blood effectively, you may have a low EF.


While most cases of low EF cannot be directly prevented, there are ways to reduce your chances of developing a heart condition that leads to it. Follow these prevention tips to help lower your risk of developing low EF:

  • Practice good heart health: Watch what you eat, exercise (as advised by your physician), and avoid smoking, heavy alcohol use and drug abuse.
  • Take your medications as prescribed: If you have high blood pressure, high cholesterol or diabetes, be certain to take your prescribed medications as directed.
  • Get regular check-ups: Heart abnormalities may be detected at a regular appointment and you’ll have the opportunity to discuss any symptoms with your physician. If you have a low EF, the earlier you’re diagnosed and treated, the better.


Low ejection fraction can be effectively treated when the heart condition causing it is treated.

Low Ejection Fraction Treatment

If you have a low ejection fraction, your physician may recommend the following treatment options to help improve low EF:

Biventricular Pacemaker

This special implanted pacemaker can help the lower chambers of the heart muscle pump together and improve cardiac function, leading to an increased heart EF.

Healthy Lifestyle Changes

Getting the appropriate amount and intensity of exercise, losing weight, quitting smoking, reducing salt or excess fluids, and eating a healthier diet are some of the recommendations for improving low EF.

Heart Transplant

Though rare, when medications, lifestyle changes or devices can’t help people with dangerously low ejection fractions and severe heart problems, a heart transplant might be an option. This is a serious surgery for treating low EF with numerous risks and a long recovery period.

Implantable Cardiac Defibrillator (ICD)

This device, implanted in the chest, sends small electrical pulses to the heart to reestablish a healthy rhythm and manage low EF.


Medications such as beta blockers or diuretics may help improve your heart function and control your low ejection fraction symptoms.

Talk to your physician if you want to learn more about how to improve low ejection fraction.


A low EF number is a serious issue, putting you at a significantly higher risk of sudden cardiac arrest.

Next Steps with MyChart

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