Ejection Fraction : Tom's heart attack... - British Heart Fou...

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Ejection Fraction

cherrabah profile image

Tom's heart attack was five months ago. Totally out of the blue, he staggered in clutching his chest - within a few minutes my 73 year old husband was being attended to by paramedics and immediately rushed to Glenfield Hospital in Leicester for four stents and a lifetime of medication. The NHS and team were brilliant and saved his life and we shall be forever grateful. Rehab has been a bit slow forthcoming, but he seems now to be 'in the system' with classes in the offing and appointments for the future.

However, we've researched and learned the score. A permanently damaged heart muscle and poor ejection fraction (40-ish) has called for gentle progressive exercise, careful diet and diligent pill taking. A steep learning curve, but sites such as this, books and cautious googling are hopefully steering us along. Just under three stone in weight loss (a good thing), with blood tests showing healthy cholesterol levels, low glucose and good enough blood pressure. A bit low, if anything. And two months ago he had a stress perfusion MRI with results last week.

To be honest, with his exercise levels creeping up to a good three miles most days, he wasn't breathless, looks really well, active ...we were privately feeling smug about hearing good news. But learned his ejection fraction was still just 41.

So what's that about? Could it be that a two month old MRI might already be outdated? Is it that his 'floppy' damaged heart muscle (which I believe can't repair) causes this low EF? Can the EF improve despite some permanent damage? Does it really matter or can life still go on okay as it is? Would be interested to read others' thoughts - thanks!

30 Replies

I can't comment on Ejection Fractions, but three stone weight loss is a terrific result.

Congratulations, Tom's clearly doing something very right!

Ah, 41% EF is a good level . Average is about 50 - 60 % .Try this group I belong to, it is a pukka one, I was given the details when I left hospital.


Hi Cherrabah, a low EF can sometimes improve but there are no guarantees.

Any significant improvement is likely to happen when he gets into rehab classes and starts working it a little harder under controlled conditions because, like any muscle, it's "doing a bit more" that strengthens it.

BUT., regardless of whether or not it increases, it's only a number. And 40% isn't a particularly bad number because of the way it's worked out.

It DOESN'T mean his heart is only pumping 40% of "normal" because "normal" starts around an EF of 50%. So his measurement is really 80% of what they'd expect.

But, more than that, it ain' t what you've got it's the way that you use it. If his 40% EF is enough for him to live his normal day-to-day life, including an excellent level of activity (3 miles daily is pretty good going!), then his heart is pumping "enough" even if it's not pumping "as expected".

It sounds like he's doing really well so try not to sweat the numbers :)

Very well worded, and much comfort, after my heart attack my EF worried me, but no one explained as well as you have here. Thank You

Thanks :)

It was one of the things I had to get my head round after mine. My EF was a very lucky "50-55%" which, when they gave the figure (without explanation) sounded like half my heart was fubar'd and ai couldn't understand why they were totally unconcerned!

Lots of careful googling later and it made sense :)

I fully agree with “thatwasunexpected” regarding 40/41% being a good number and in real terms approx 80% of what is expected. Before my cardiac arrest I was scuba diving / cycling and hill walking and it turned out I only had an EF of 10% now with a CRT-D and medication it’s up to 33% and I’m back up to ten miles a day walking although mainly on the flat. I may be nine years younger than your husband, but if you listen to the experts, exercise every day without overdoing it and look after your weight etc it won’t be long before life is back to normal. You will most likely find the hardest hurdle to overcome is the mental one, luckily for me I’m a glass half full type of person.Good luck for the future and working together you will both get there. Finally to quote a very well know elderly gentlemen (Captain Tom) “Tomorrow will be a good day “

And I think you should carry on feeling smug!!!He's doing really well, so well done both of you.

My husbands HA was just over a year ago and he has lost weight, upped the exercise steadily and we get on with things now. In fact, I think my dodgy knees and afib cause more day to day issues!

The ejection fraction is just a number and not as awful as it sounds.

Take care.

My mother's was 30% after suffering 2 heart attacks in a span of 2 days, she went on to live 17 more years of a quiet life , in that she never adopted an active lifestyle, and passed away at 90 years of age. So great news for your husband and congrats. To him for being proactive going forward.

I wish I had an EF of 40%. Mine is around 20%, for no obvious reason, but I am coping reasonably well, I hope. Sounds as if your husband is doing well, just encourage him with the exercise routines!

Hi Cherr just want to say I had ha hf 3 years ago Ef 29 had mri again a year ago ef the same 29 the first 6 to 9 months went through all the norm worrying panicking phoning the nurse 5 times a day thinking with every pain it was over after months of stressing it just wore off and iv been so much better since Iv stopped worrying I do panick sometimes but very rare these days I’m convinced it’s how you feel that makes things better sorry I’m not to good at explaining things godbless you both kwagmire ??

Hello Cherrabah,I had HA and stent may 20.

My last echo gave EF at 44%,(age59).Since HA I've lost 10/11ks although exercise is not as much as I was doing.

If Tom is reasonably OK try not to worry too much, he seems to be doing great.

Hello Cherrabah

My husband had his heart attack 3 years ago. We were initially told that his ejection fraction was 41 % but a month or so later it had gone down to 32%. We now think the initial percentage was wrong because it has stayed at around 32%. We were very worried at first and desperate for it to increase but we have now got used to it and realised it actually doesn’t matter. He is quite fit and active, can walk 6-7 miles quite easily and leads a reasonably normal life. He does get tired if he does too much over a few days and we have learnt to pace ourselves a lot more, but on the whole we just consider ourselves lucky that he is still here and life is continuing. I hope that your husband continues to do well and I would say keep walking and try to focus on how he is feeling rather than the number x

I was left with heart damage after a huge HA caused by a blood clot in my left artery. I was left with 31 percent EF. 18 months on I can walk 10k without any problems at a good pace. Sometimes do more . Im on a real cocktail of meds but hey, they keep me alive. Pre HA I was a keen runner, running 40 miles a week. Just recently getting back into slow running. I have cut out red meat almost completely, only eating as a rare treat. I have swapped to eating fish with 3 or 4 portions of oily fish per week ( I chose mackerel). I ate lots of healthy stuff before but did have an incredibly sweet tooth. I've cut a lot of the sweet stuff out and swapped milk chocolate for dark but only eat a small amount of it per day (6 squares) 25g . It's hard to begin with but my body feels better than ever, even running on a lower EF.

I am so interested in the positive posts about the levels of ejection fraction. I am 75 and have been diagnosed with aFib and DCM last year As far as I know my ejection fraction is 41%. However, despite the usual cocktail of drugs my breathing and energy levels are pants. Any exertion makes me breathless. Can't even walk to the end of the road without being exhausted. I am getting progressively worse. I am not overweight, never have been, not diabetic. I used to sail, own boat which I am selling as I can't manage her. Walk distances, garden, do a yoga class and now can't carry a tea tray upstairs! I try not to get depressed but I do feel the rug has been pulled out from under me. Sorry for the pity post, I'll take a look at the link Rowan, thank you.

marigoldb profile image
marigoldb in reply to Silvasava

Dear Silvasava, what actually is DCM? sorry to show my ignorance. I can identify with your symptoms, but mine were due to aortic stenosis. When are you seeing your cardiologist again?

I had a new aortic valve and single coronary bypass graft from the mammary artery 2 years ago. Thankfully no more breathlessness going upstairs etc.

I had the op aged 83.

So thankful to my cardiologist who had been monitoring me since 2006! And

My surgeon and team at Harefield Hospital, part of the Royal Brompton.

I remain on Apixaban, Bisoprolol, and Avorastatin.

Other medical issues, no need to mention, but although in the slow lane so to speak, find you have time to see much more from there!

Do hope your health will improve, and yes, you can feel sorry for yourself, we all can at times, and we are here to listen, so no need to apologise.

Sending my best wishes to you x. Marigold

Silvasava profile image
Silvasava in reply to marigoldb

Thank you for your lovely reply Marigold and so pleased you were able to have surgery to improve your quality of life. Apologies for using an acronym! It stands for Dilated Cardiomyopathy and like Cherrabah's hubby there is no surgical procedure able to correct it so its medication only. I only had it confirmed at the end of April this year although I suspected it when the cardiologist wouldn't countenance another cardioversion (only had 1) or an ablation for my aFib.

At the moment I am on Entresto, Edoxaban, Spironolactone,Nebivolol,Digoxin, Furosemide and Atorvastatin! Ive been on Levothyroxine for over 30 years and that is stable as I have no thyroid. As Bette Davis says - Old age aint for sissies!

Hi Its interesting ( & pleasing) that you don’t use the term heart failure which is, in effect what the medics generally call a heart damaged in this way. My husband’s story is much the same - HA out of the blue.. EF 40%. Although he had no weight to lose. He now has an ICD & continued to be fairly well since the ‘event’ 5 years ago, initially gym work & doing lots of walking. We eat a varied diet with lots of fruit and veg but still have treats and wine. As someone else said mentally it takes some work & this was a challenge - it’s the shock. He is starting to slow down now, but that could just be a general ageing. We have found pumpingmarvellous.org has lots of info about medication, exercise, handling symptoms. Might be worth a look. Good Luck to you both.

Silvasava profile image
Silvasava in reply to MissisF

Yes,the term Heart Failure makes people think you're going to keel over at any minute!!

I was interested to read all the comments saying that an EF of 41% is not too bad and people are still living a normal, active life with that level. I had open heart surgery to repair my mitral valve in 2018 (after the mitral regurgitation had been monitored for 3 years and deteriorated to severe). I never had any symptoms, no breathlessness at all and did a lot of exercise, had no idea that anything was wrong with my heart until a routine checkup revealed the problem. Immediately before my surgery my EF was 62% and immediately after it was 63%. I had regular checkups with the cardiologist after the surgery and all was fine until November 2020 when I was told that my heart function was not as good as it should be and the EF was now 41%. I have no idea why that deterioration had happened for no apparent reason after the problem had been corrected by surgery, all the cardiologists say that the results of the surgery are excellent. I saw another cardiologist in March this year and asked him why this should be, and the reply was that this can sometimes happen if someone has had a heart condition for many years (which I might well have had, unbeknownst to me). He referred me for a cardiac MRI which I have had, and also a nuclear medicine scan of the heart but my appointment for that is not until September so I won't see the cardiologist until after he has the results of that. He just says to carry on living my normal life, but I am worried that my EF has already dropped by over 20%, in case in continues to deteriorate. The cardiologist did prescribe ramipril 2mg for me in addition to my other medication (bisoprolol and pitavastatin plus a low dose aspirin) and I feel fine on that (they tried enalapril first but it did not suit me as it made my blood pressure too low - I don't have high blood pressure to start with).

Heart attack 18+ years ago at 55 and lost my circumflex artery for good. Did not bad for 11 years before being diagnosed with A/F and H/F in 2014. Since then continued to golf, walk a couple of miles , and garden, until I had a blackout while driving in 1919. Now have had fancy CRT-D high tech pacemaker for a year and still managing 13 holes and gardening with only symptom being easily very fatigued. EF fell to 35-40 7 years ago and now may be around 25-30 but have been told the EF figure is secondary to that number, and it is the severity, and types, of symptoms that cardiologist really go by. so you and your husband should not worry too much. Ian F

Hi,My ejection fraction improved from 17% to 31% and seems to have stalled, but with medication I feel pretty normal, mine was caused by a virus I didn't know I'd had. I garden quite vigorously and walk (but not as far as I should,) periods of activity then rest seem to be the way to go.

Hi, the taking of the EF is not an exact science, I don’t think 2 people checking it would give you the same answer, so don’t get hung up on the figure, it’s how you feel and if you feel good it’s all good.

Thank you all so much for your wise, encouraging and positive words - much appreciated!! 👍😊 x

Well done. The weight loss sounds terrific, and 3 miles a day is good. Many people are not doing anywhere near that in good health. Keep it up. Thatwasunexpected has good advice. Take care, and best wishes.

Hi CherrabahI don't think you really need to focus on the ejection fraction, as Rowan666 said, 41% is quite good, please don't think that percentage is out of 100, I was told 55% is pretty much perfect by my consultant. When I found out about my heart failure my EF was 14%, but continuing exercise and healthy (ish) eating, plus medication, after 2 years mine went up to 48%. As you can imagine, I was ecstatic! It seems to me that Tom has lots of support from you and with determination I'm sure he'll make great strides, he's obviously on the right path, Good luck x

My EF increased from 17 when first diagnosed with Heart Failure and has been at 43% for the last 3 years. I was discharged from the HF clinic at our local hospitals to GP care at that time.

However because I volunteered to take part in research about HF possibly being within families at Harefield I am now looked after by them.

I also have Dilated Cardiomyopathy.

I have an ICD.

There is an excellent book on HF produced by the BHF and I was given one when first diagnosed. It advises on diet, liquid intake, the dreaded salt and also exercise.

You can download it from the BHF website. I will find the link tomorrow and post it on here.


Here we are, finally managed to find it on the BHF site.


Many thanks for that link - look forward to devouring all that information, and good to know it comes from such a reliable source. Much appreciated 👍!

40 pct is not too bad Cherrabah. My Mum in Frinton UK has an LVEF of a little over 30 ( for many years ) She is 101 today - born in Ayrshire 28 July 1920. Alert and well.

cherrabah profile image
cherrabah in reply to Smileyian

Happy birthday and congratulations to your mum! 👍😊🎂 What a lovely upbeat post, thanks!

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