Management of the underlying condition (e.g., hypertension, coronary artery disease) is an essential step in the management of a low ejection fraction. It is important to note that low ejection fractions caused by conditions such as heart failure or cardiomyopathy are often irreversible. Treatment should be focused on reducing symptoms and preventing the progression of the disease. These strategies include lifestyle changes, medications and procedures such as the insertion of an implantable defibrillator (ICD).

Lifestyle choices that may be recommended to patients with an abnormal ejection fraction include:

Medications to reduce the heart’s workload, increase blood flow, widen vessels or eliminate excess water from the body may be prescribed. These medications may include:

• Inotropes (such as digoxin). Helps the heart to contract more vigorously and effectively, and helps to reduce symptoms.
  
  
• ACE inhibitors. A type of vasodilator that expands blood vessels to allow blood to flow easier and more freely, allowing the heart to pump more efficiently. These agents are standard in the treatment of low ejection fraction, particularly in the presence of clinical heart failure. ACE inhibitors are also used to control and reduce high blood pressure (hypertension). 
  
  
• Angiotensin II receptor blockers. Similar to ACE inhibitors, these medications reduce the stress on the heart muscle and may benefit patients with diabetes and heart disease. The medication apparently protects the kidneys from the diabetes-related complications.
  
  
• Diuretics. Medications that cause the kidneys to flush water and other substances (e.g. sodium) from the body through urine, thus reducing blood pressure.
  
  
• Beta blockers. These medications may improve symptoms by slowing the heart’s contraction rate and reducing its pumping action, thus lessening the heart’s workload.
  
  
• Alderosterone antagonists. These drugs are used to prevent sodium and water retention and scarring of the heart muscle. They are generally reserved for patients with more severe heart failure.

Depending upon the cause of the depressed ejection fraction, certain procedures may be recommended, such as the insertion of one of the following:

• Implantable defibrillator (ICD). This implanted device monitors for and, if necessary, corrects an abnormal heart rhythm by sending electrical charges to the heart. An ICD may benefit patients who have experienced serious episodes of fainting (syncope) or arrhythmias associated with a low ejection fraction. In particular, ICDs are used to prevent ventricular fibrillation, an abnormal heart rhythm that can lead to rapid sudden cardiac death if not immediately treated.  ICDs may also be built in to biventricular pacemakers. In select patients, biventricular pacemakers have appeared to improve ejection fraction and exercise tolerance. This form of therapy is known as cardiac resynchronization therapy.
  
  

  

• Ventricular assist device. An implanted device that helps one of the heart’s lower chambers (ventricles) to pump blood. These are used primarily as a “bridge to transplant,” meaning that they help patients with low ejection fractions while they await a heart transplant.

A promising treatment being developed for depressed ejection fraction is gene therapy. Researchers continue to explore the nature of stem cells in the treatment of many diseases. Stem cells are immature cells, meaning they have the ability to develop into a variety of mature cells, such as red or white blood cells, platelets, heart muscle cells, brain cells, etc. For example, recent studies have reported encouraging findings after transplanting stem cells taken from patients’ own bone marrow into heart muscle following a heart attack.

For heart failure patients, bone marrow cells have been injected into the heart’s left ventricle. Other studies have shown promising results in the use of muscle cells taken from other parts of the body (e.g., thigh) and injecting them into damaged areas of the heart. It is believed that such skeletal muscle helps to restore the contractile properties of affected heart muscle, thus improving ejection fraction. However, these treatments are still experimental and have not been approved by the FDA.