Definition and Overview

Systolic heart failure is a medical condition in which problems in the left ventricle prevent the heart from effectively pumping enough blood to the body.

Systolic is a medical term that refers to the maximum arterial pressure when the left ventricle contracts. In contrast, diastolic blood pressure indicates how much pressure the blood is exerting when the heart is resting in between beats. In a blood pressure reading, the systolic pressure is the first number recorded and the diastolic pressure is the second number.

Heart failure, on the other hand, refers to a medical condition in which the heart weakens. In the majority of cases, the condition occurs as a result of problems in systolic blood pressure. When the left ventricle is unable to contract normally, the heart is left with inadequate force to push enough blood to the rest of the body. Sometimes, heart failure develops due to diastolic dysfunction in which the left ventricle becomes stiff, preventing the heart from filling with enough blood during the resting period between each beat.

In normal circumstances, the heart pumps 60% of the total blood volume it receives during each beat. This is called the ejection fraction. If the ejection fraction is less than 40%, symptoms of heart failure will develop.

Causes of Condition

Systolic heart failure is commonly the result when the heart is forced to work harder due to heart valve malfunction or heart disease. For example, if coronary arteries are blocked and the blood flow to the heart muscles becomes limited, the heart will try to compensate by expanding and attempting to increase its pumping power. The heart’s chamber also stretches and enlarges to accommodate a larger volume of blood. Over time, these extra work take a toll on the heart and its ability to pump blood is compromised. This leads to the development of heart failure symptoms, including difficulty breathing and chest pain.

The following conditions can damage or weaken the heart and cause heart failure:

  • Heart attack

  • High blood pressure

  • Heart valve problems

  • Cardiomyopathy

  • Myocarditis

  • Arrhythmias

  • Congenital heart defects

Key Symptoms

Systolic heart failure symptoms begin to show when the heart is unable to pump enough blood throughout the body. Without an adequate supply of oxygen-rich blood, various organs begin to malfunction. When this happens, patients will experience:

  • Breathing difficulty - When heart function is compromised, the blood is unable to efficiently move from the lungs to the heart. As blood accumulates in the lungs, a person experiences breathlessness especially during certain activities or while exercising.

  • Chest pain

  • Decreased mental function - Inadequate blood supply to the brain can lead to impaired thinking and memory loss.

  • Fatigue and weakness - When not enough blood is circulating throughout the body, various organs are left with inadequate supply of oxygen and nutrients. To compensate, the body takes measures by focusing resources to crucial areas, such as the heart and the brain. Less crucial areas, including the legs and arms, will have less blood supply, resulting in the feeling of fatigue, weakness, and even fainting.

  • Fluid retention - Inadequate blood supply can lead to water and salt retention.

  • Lack of appetite

  • Lightheadedness

  • Nausea

  • Ascites, or abdominal swelling due to the accumulation of fluid in the peritoneal cavity

  • Rapid or irregular heartbeat

  • Swollen lower extremities

  • Wheezing

Who to See and Types of Treatments Available

Heart failure is diagnosed with the following tests and procedures:

  • Review of the patient’s complete medical history

  • A thorough physical exam

  • Blood tests - Performed to check thyroid, liver, and kidney function

  • Imaging tests - Chest x-ray, cardiac computed tomography (CT) scan, and coronary angiogram provide doctors clear images of the heart and surrounding structures. Echocardiogram is also performed and is useful in distinguishing systolic from diastolic heart failure. The procedure produces clear video images of the heart, allowing doctors to easily spot any abnormalities.

By combining the results of the above tests and procedures, doctors are able to determine the stage of heart failure, which is an important factor in determining the best possible treatment plan for the patient.

  • Class I - Heart failure has been confirmed but patients don’t show any symptoms

  • Class II - Patients easily feel fatigued when exerting themselves

  • Class III - Heart failure symptoms keep the patient from performing everyday tasks

  • Class IV - Severe case of heart failure in which the patient is having breathing difficulty even when resting

Treatment of systolic heart failure focuses on correcting the underlying cause. For example, widening a narrowed or blocked blood vessel that supplies blood to the heart can help lower blood pressure. This eliminates the extra workload for the heart, which can result in symptoms relief.

Heart failure can be managed with life-long drug therapy. Drugs that are often used include:

  • Digoxin (Lanoxin) and Inotropes - Increase the strength of heart muscle contractions while slowing heartbeat

  • Diuretics - Help eliminate extra water in the body to lower blood pressure

  • Angiotensin-converting enzyme (ACE) inhibitors - Help dilate or enlarge blood vessels to reduce blood pressure

  • Beta-blockers - Treats high blood pressure and angina (chest pain)

Heart failure medications can be combined with other types of drugs, such as cholesterol-lowering and blood thinning medications, depending on the patient’s risk factors.

In cases where lifestyle changes and medications are not enough to manage or treat the underlying cause of heart failure, surgical procedures are performed. These include:

  • Implantable cardioverter-defibrillators (ICDs) - ICDs, which are implanted under the skin in the chest area, are used to regulate the heart rhythm to prevent arrhythmia from occurring. If abnormal rhythm is detected, the ICD will pace the heart, making it beat slower or faster to achieve normal rhythm.

  • Heart pumps - These battery-operated devices are surgically implanted either in the chest or abdomen, helping the heart maintain its pumping ability. Previously, these devices were exclusively used for patients awaiting heart transplant. Now, however, they are commonly being used in longer-term therapy and for patients who do not qualify for heart transplantation.

  • Cardiac resynchronisation therapy (CRT) - Treats heart failure caused by irregular heart rhythm or arrhythmias. Clinical studies have shown that this therapy is effective in improving heart’s efficiency, alleviating heart failure symptoms, and decreasing hospital visits and morbidity.

  • Heart transplant - Reserved for end-stage heart failure, this procedure involves replacing a person’s diseased heart with a healthy heart from a deceased donor.

Despite numerous advances in the field of cardiac care, heart failure remains to have a poor prognosis. The five-year mortality rate for patients with class IV symptoms is over 40%.


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  • Hjalmarson A, Goldstein S, Fagerberg B, et al; for the MERIT-HF Study Group. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). JAMA 2000; 283:1295–1302.

  • Heart failure (HF). The Merck Manual Professional Edition.

  • Page RL, et al. Drugs that may cause or exacerbate heart failure: A scientific statement from the American Heart Association. Circulation. 2016;134:e32

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