A Guide to Understanding Your Heart’s Ejection Fraction

Your ejection fraction is a measure of how well your heart is pumping. If you have heart failure, or if you’re getting certain forms of chemotherapy, you’ll probably get your ejection fraction measured regularly. If you don’t have any heart issues, then you may never need your ejection fraction tested. In this article, we’ll dive into what ejection fraction means, how it’s tested, and the ways that this number might impact your health.

What is ejection fraction?

Ejection fraction (EF) is a way to measure how well your heart is pumping blood. Each time your heart beats, it squeezes out some, but not all, of the blood inside. EF is the percentage of blood that gets pumped out with each beat. 

A normal ejection fraction means your heart is pumping well. If the number is too low or too high, it could be a sign that your heart isn’t working the way it should.

How is ejection fraction measured?

Ejection fraction is measured with special imaging tests that take pictures of your heart. There are several options. These include:

• Echocardiogram: An echocardiogram is an ultrasound test of the heart, which means it doesn’t require radiation. This test looks at the chambers of the heart, the heart muscle, and the valves. For most people, an echocardiogram is the best way to measure EF.

• MUGA scan: A MUGA scan is a test that involves injecting a small amount of a radioactive medicine into a vein. This test is done to measure the strength of the heart, but it doesn’t tell you about your heart valves or other heart structures. Sometimes this is the best choice if the heart can’t be seen well on an echocardiogram.

• Cardiac CT scan: A cardiac CT scan is a test that uses a small amount of dye injected into a vein to create detailed images of the heart, including your blood vessels and often the lungs, too. CT scanning involves radiation.

• Cardiac MRI: Cardiac MRI is an imaging test that uses special magnets combined with an injection into a vein. This test shows the heart in great detail. It doesn’t involve radiation. 

• Cardiac catheterization: Cardiac catheterization is a procedure done under sedation. A thin tube called a catheter is placed into an artery of the arm or leg, then threaded into the heart. This test is done by a cardiologist, and it’s usually ordered when there’s concern about a blocked artery. Like a CT scan, this test uses radiation to see the heart.

Though these tests use different methods, they’re all accurate ways to measure EF. All of them can be done in a medical outpatient office, except for cardiac catheterization. This is usually done in a hospital. 

What is a normal ejection fraction?

When measured with an echocardiogram, a normal ejection fraction is:

• Between 52% to 72% for men 

• Between 54% to 74% for women

If your EF is slightly higher or lower, it doesn’t always mean something is wrong. But your healthcare team may recommend a follow-up test to check for changes over time.

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The following ranges are considered abnormal:

• Mildly reduced: 41% to 51% for men, and 41% to 53% for women

• Moderately reduced: 30% to 40% 

• Severely reduced: Under 30% 

What does it mean if you have a low ejection fraction?

A low ejection fraction means that the amount of blood that your heart pumps out with each beat is less than normal. This can cause congestive heart failure. Congestive heart failure means that your heart can’t pump enough blood to keep up with your body’s needs.

Your EF can be reduced by many different things. Some of these conditions can reverse, though others may be permanent. And sometimes, even if the underlying condition is still there, the heart strength may improve with treatment.

Conditions that can cause a low ejection fraction include:

• Heart muscle damage from a heart attack

• Damage to the heart due to viral infection

• Genetic conditions

• Hypertension (high blood pressure)

• Heart valve problems

• Obesity

• Some types of arrhythmia (irregular heart rhythms)

• Critical illness, such as severe infections 

• Some forms of chemotherapy

• Kidney failure

• Certain toxins (like excessive alcohol, cocaine, and amphetamines)

Some people have a normal ejection fraction but still have congestive heart failure. That happens when the heart muscle is abnormally stiff. This is called “heart failure with preserved EF” or “diastolic dysfunction.” Your cardiologist will check certain measurements on your echocardiogram or other heart testing to see if this is an issue for you.

What does it mean if you have a high ejection fraction?

When an ejection fraction is abnormal, it’s more common for it to be low than high. Your EF will naturally increase with exercise or temporary stress, but it usually will return to normal within 10 minutes. If your EF stays above the normal range, it usually means that there’s something going on in your body that’s making your heart work too hard.

Conditions that can cause a high EF include:

• Certain types of heart muscle disease, including hypertrophic cardiomyopathy

• Hyperthyroidism

• Severe infection (such as sepsis)

• Anemia

• Psychological stress

Can you improve your ejection fraction?

If you’re diagnosed with a low ejection fraction, it doesn’t mean it’ll always be low. In many cases, your ejection fraction can improve with treatment.

Depending on the cause of your low ejection fraction, medication can often make a big difference. 

Examples of medications for low ejection fraction include:

• ACE inhibitors: like lisinopril (Zestril) and ramipril (Altace)

• Angiotensin II receptor blockers (ARBs): like valsartan (Diovan)

• Angiotensin receptor-neprilysin inhibitors (ARNIs): like sacubitril / valsartan (Entresto)

• Beta blockers: like metoprolol (Toprol) and carvedilol (Coreg)

• Diuretics: like furosemide (Lasix) 

• Aldosterone receptor antagonists: like spironolactone (Aldactone)

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors: like empagliflozin (Jardiance) and dapagliflozin (Farxiga)

Most people with a low EF will need to take several of these types of medications to get the best results. That’s because these drugs usually work best when combined. 

In some cases, more invasive treatment is needed to help improve your ejection fraction. That might include:

• Coronary stent

• Coronary bypass

• Heart valve surgery

• Pacemaker

If your ejection fraction remains low and your symptoms are severe, you may be a candidate for a left ventricular assist device (LVAD) or a heart transplant. But this is less common.

You can also improve your ejection fraction with cardiac rehabilitation. This can help to improve your heart’s strength and flexibility. And your healthcare team will work with you to optimize your nutrition and other lifestyle factors, too.

Not everyone will get an increase in ejection fraction with exercise and lifestyle changes. It may depend on the cause of your low number. If your ejection fraction is low because of a heart attack, there’s good evidence that a carefully structured exercise program may improve it.

If you have a low ejection fraction, a heart failure specialist can be a valuable member of your healthcare team. People who are cared for by a heart failure team tend to live longer and have access to more specialized treatment that can improve quality of life.

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Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology and the American College of Physicians, among others.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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