What are the types of heart failure?

Dr. Boris Arbit, MD

There are two types of heart failure: preserved ejection fraction and reduced ejection fraction. Half of the people with heart failure have a preserved ejection fraction, and the remainder display a reduced ejection fraction. (An ejection fraction is thought of as the overall squeezing or pumping function of the heart.)

With heart failure with reduced ejection fraction (also known as systolic heart failure or dilated heart), the heart becomes very large. The walls become very thin, and the muscle, the pumping function of the heart, decreases. With diastolic heart failure, or heart failure with preserved ejection fraction, the opposite is happening. The muscles actually become thick. The myocytes, the actual muscle cells, become much thicker as well, and there's fibrosis around those muscles. The ventricle becomes very stiff.

When doctors look at people with systolic heart failure with an echocardiogram, they see a person with a very large heart. The chamber itself is large, it's dilated. The muscle and the walls are very thin. When the heart is squeezing, the muscle itself is not thickening very well.

In a person with heart failure with preserved ejection fraction, it's the opposite. That person has a big muscular heart that’s pumping away. Many people go undiagnosed because, following the echocardiogram, it's very easy to say, "Look at how muscular your heart is, and how well it's pumping. That can't be the reason for your shortness of breath." But it probably is.

Linda Rohyans
Cardiac Rehabilitation Specialist

Heart failure is described in many ways to help individuals understand the complexity of this chronic illness. The New York Heart Association (NYHA) has classified heart failure into four classes: Class I, Class II, Class III and Class IV. As the individual moves from one class to another, so do the severity and intensity of the reported symptoms experienced by the individual. As a compliment to the classes of heart failure, the American Heart Association (AHA) and American College of Cardiology (ACC) have identified stages of heart failure: A, B, C and D. Again, as the individual transitions from one stage to the next, the clinical severity of the individual's heart failure worsens.

The ejection fraction (EF) is an objective measurement that has been used to assist healthcare providers in the treatment of heart failure; as it is an indicator of how well the heart is able to receive and then pump the blood throughout the body, as the needs of the body require it. Left ventricular systolic dysfunction (LVSD) has been a term used to describe an EF that is reduced; the "squeeze" of the heart has been weakened. A newer term for LVSD has recently been identified as "HFREF," meaning, Heart Failure with Reduced Ejection Fraction. Left ventricular diastolic dysfunction (LVDD) has been a term used to describe to what capacity the heart is able to "relax" in order to receive blood. Individuals with LVDD may have an EF that is within normal limits or preserved. The newer term for LVDD that has recently been identified is "HFPEF," meaning, Heart Failure with Preserved Ejection Fraction. Some individuals have a combination of both conditions with their heart failure.

There are many ways to describe and define heart failure, as you can see. So, the best way to stay on top of what is happening with your heart failure is to ask questions, learn about your health condition and have your health care team inform you as to your type of heart failure.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.