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Q: I was recently diagnosed with heart failure. On my discharge paper work from the hospital, it says I have "heart failure with preserved ejection fraction." What does that mean?

A: Since you were admitted to the hospital with heart failure, you likely had symptoms such as shortness of breath, leg swelling, fatigue and difficulty doing everyday activities.

Getting a diagnosis of heart failure can sound very scary. But it doesn't mean your heart is about to stop working. It does mean that the heart is not pumping blood into your body as well as it should.

Doctors order a number of tests to help determine the cause and the type of heart failure. One of those tests is an echocardiogram, an ultrasound exam that shows how well the heart is pumping. A measurement known as the ejection fraction, or EF, refers to the amount of blood pushed out (ejected) with each heartbeat. A normal EF is 50 percent to 70 percent.

An EF in the range of 41 percent to 49 percent is considered borderline low. An EF of 40 percent or lower suggests heart failure with reduced ejection fraction. This type of heart failure, which used to be called systolic heart failure, happens because the heart muscle doesn't contract effectively. It can occur after a heart attack, but there are many other possible causes, including severe, untreated valve disease or a viral infection.

However, about half of people with heart failure have a normal EF. Formerly known as diastolic heart failure, this condition is now referred to as heart failure with preserved ejection fraction. I strongly suspect that your EF was in the normal range.

Your heart contracts with plenty of strength, but the lower chambers (ventricles) are stiff and thickened, so they do not relax to allow normal filling. This type of heart failure is more common in older people, and is often associated with a prior history of high blood pressure.

People with heart failure usually need to take diuretics (sometimes called water pills), such as furosemide (Lasix) to eliminate excess fluid from the body. But for those with a stiff left ventricle dosing can be tricky, because even a little too much diuretic can lead to low blood pressure.

While certain medications have been shown to improve the outcome for people with reduced ejection fraction, no optimal drug program for those with preserved ejection fraction has been identified. So, the other heart drugs you may need will depend on your personal circumstances, such as your blood pressure readings and kidney function.

Eating a healthy, low-salt diet and losing weight if necessary are important for people with heart failure. You will want to stay physically active. Ask your doctor for advice on how to get started on an exercise program.

(Howard LeWine, M.D., is an internist at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit

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