Your echo says ‘normal ejection fraction.’ What about filling?

What does ejection fraction measure?

The left ventricle is the main chamber that sends blood around your body. Its ejection fraction, usually written EF or LVEF, is the percentage of the blood inside that chamber that leaves when it contracts.

An EF of 60% means the chamber pushes out about six-tenths of the blood it contained before that beat. It does not mean your heart is only 60% healthy or that the remaining 40% represents damage. The chamber normally keeps some blood inside.

The American Heart Association describes a usual normal range of 55% to 70%. Your report’s method and reference range still matter. A higher percentage is not automatically a better result, and the percentage alone does not measure how well every part of your heart works.

Sources: 1

Squeezing and filling are different parts of the same beat

Systole is the squeezing phase. Diastole is the period when the chamber relaxes and fills again. An echo uses moving ultrasound pictures and measurements of blood flow and tissue movement to examine these functions.

A chamber can squeeze out a normal percentage while having difficulty relaxing or filling without a rise in pressure. That is why an echo report may describe preserved pumping function alongside a finding about diastolic function.

The clinician interpreting filling looks at several measurements together. Heart rhythm, blood pressure, age, valve problems and the quality of the images can affect interpretation. One highlighted number cannot supply the whole answer.

Sources: 1, 2

Does ‘diastolic dysfunction’ mean heart failure?

Those words describe an abnormality in relaxation or filling. On their own, they do not establish that you have heart failure. A mild finding on a report should be discussed in the context of your symptoms, examination and other results.

Heart failure with preserved ejection fraction, or HFpEF, is a clinical diagnosis. It involves heart-failure symptoms or signs with a preserved EF and supporting evidence of raised filling pressures, at rest or with activity. A clinician also considers other explanations for breathlessness or reduced stamina.

Depending on the situation, assessment may include blood tests such as BNP or NT-proBNP, which can provide information about stress on the heart, and other testing. These are not automatic additions for every woman with a diastolic comment on an echo.

Sources: 2, 3, 4

What else is the report describing?

An echo examines more than the left ventricle’s pumping percentage. The summary may mention the other chambers, muscle thickness, valves or the sac around the heart. Ask your clinician which findings matter to the reason the test was ordered.

Words such as trace, mild or moderate describe the degree of a particular finding. They do not tell you, by themselves, what treatment is needed or whether that finding explains how you feel.

Sources: 2, 5

What can a resting echo leave unanswered?

A usual echo taken while you are resting is not the same as a stress echocardiogram. The latter examines how the heart responds to exercise or medicine. A resting study cannot describe everything that happens when you climb stairs.

A normal resting echo also does not exclude plaque in the coronary arteries or a rhythm problem that occurs at another time. Those questions may call for a different approach when your symptoms or history give your clinician a reason to investigate.

That does not mean you need a collection of tests after a normal result. It means the result should be matched to the question it was intended to answer.

Sources: 4, 5

Compare what different heart tests can show

If you are still short of breath, describe what changed

Tell your clinician if a familiar walk now requires a stop, if breathing feels harder when you lie flat, or if you have noticed swelling. Include when the change began and whether it is getting worse. These details help direct the assessment; they cannot identify the cause on their own.

Bring your medicine list and relevant history, including any heart problem during or after pregnancy. Mention whether an earlier echo was performed at a different point in an illness or treatment.

A reassuring EF should not be used to dismiss new symptoms. Severe breathlessness, fainting or possible heart-attack symptoms need emergency care. Call 911 rather than waiting for a routine report-review appointment.

Sources: 4, 6, 7

Bring the whole report to the conversation

Save the report with its date. If you have a previous study, bring that too. Ask which findings were reassuring, which need attention, and whether the comparison shows a meaningful change.

Before you leave, make sure you know whether anything needs follow-up and who will arrange it. If symptoms remain unexplained, agree on what to do next and what change should bring you back sooner. Your Heart Story has space for the test, the symptoms and the question you still want answered.

Sources: 4, 5

Add an echo and your questions to your Heart Story