Systolic heart failure: Causes, symptoms, and treatment

Systolic heart failureSystolic heart failure, also known as a systolic dysfunction, is one of the most common types of heart failure and it typically affects the left ventricle of the heart. The left ventricle does most of the heavy lifting when it comes to pumping blood through the heart. Systole is the critical phase of each heartbeat when the blood is pumped through the heart and sent to other parts of the body.

Ejection fraction is the term used for measuring the exact amount of blood that’s being pumped through the different ventricles in the heart at any given time. A normal ejection fraction through the left ventricle should be about 55 percent or more per heartbeat. Any amount lower than that can lead to systolic heart failure, which is essentially a lack of sufficient blood supply being pumped through the heart.


Systolic heart failure occurs when the left ventricle becomes enlarged or inflamed to the point that it’s unable to fully contract. This prevents it from pumping blood with a strong enough force, which means other parts of the body won’t receive sufficient blood supply or the nutrients they need to function normally.

This condition is typically the result of severe or advanced heart disease including high blood pressure, coronary artery disease, cardiomyopathy, and heart valve problems.

Keep reading to gain a comprehensive understanding and definition of systolic heart failure.

What are the causes and symptoms of systolic heart failure?

Causes of systolic heart failure

The following are some of the causes of systolic heart failure:

High blood pressure

Essentially, high blood pressure puts a great deal of strain on your heart because it’s forced to work a lot harder than it normally would to produce the same amount of ejection fraction. The harder your heart has to work to accomplish this normal task, the thicker the heart muscles get. This makes it increasingly difficult for the ventricles to contract to their full potential. The longer this condition progresses or is left untreated, the more it actively weakens the heart muscles because they’re forced to expand or dilate beyond their natural capabilities.

Coronary artery disease

With gradual damage over time, your heart may become ischemic, which means it’s not receiving or absorbing a sufficient amount of oxygen. This can either be a chronic or occasional condition depending on the circumstances involved. If it’s a chronic condition, it can increasingly damage different portions of your heart over time as your heart is forced to work harder and harder to pump blood throughout the body, eventually becoming incapable of performing this task.


As the heart becomes increasingly engorged over time, it becomes a lot harder to pump blood through it and the added pressure can severely damage its internal functionality and structure. This can cause the blood to back up into the lungs or overfill the heart valves. There are four main types of cardiomyopathy: dilated cardiomyopathy, hypertrophic cardiomyopathy, ischemic cardiomyopathy, and restrictive cardiomyopathy.

Mitral valve regurgitation

The primary function of the mitral valve is to open as increased pressure occurs and the left atrium fills with blood. Then, the blood is transported into the left ventricle and the heart expands, known as diastole. When the heart contracts (systole) and pushes the blood into the aorta, the mitral valve should close. If the mitral valve doesn’t close completely, then the blood can leak back into the left atrium as the left ventricle contracts. The more often this happens, the more pressure is placed on the left ventricle to pump increasingly greater volumes of blood. This can cause functional and internal damage over time. The ventricle is forced to expand to accommodate the unnaturally large volumes of blood left behind and this can lead to heart failure.

Symptoms of systolic heart failure

The following is a list of the most common systolic heart failure symptoms:

  • Persistent coughing and wheezing, sometimes coughing up bloody mucus
  • Shortness of breath, dyspnea (labored or heavy breathing) that’s exacerbated when you lie down on your back, making it difficult to fall asleep
  • Weakness throughout your entire body
  • Heaviness in the chest, sharp chest pains that permeate through your arms
  • Heart palpitations
  • Weight gain as a result of fluid retention
  • Reduced tolerance for physical activity

Diagnosis of systolic heart failure

As with other potentially dangerous or fatal physical conditions, early detection and diagnosis of systolic heart failure are crucial to effective treatment and manageability of symptoms. There are a variety of diagnostic methods that doctors might implement when it comes to accurately determining whether you might be suffering from a systolic heart failure. These include the following:

  • Blood tests gauge and test a variety of different bodily functions including the health of your kidneys, liver, and thyroid.
  • Stress tests such as exercise are used to observe how quickly the heart is able to work under difficult circumstances. If a patient is unable to sustain highly intense physical activity, then an EKG test and medication are used as a substitute.
  • Chest X-rays can also effectively demonstrate the size and functionality of the heart to show whether it’s working normally. It can also indicate whether there’s an abnormal fluid buildup inside the lungs.
  • Electrocardiograms are used to determine whether the heart is abnormally enlarged as well as the intensity of electrical activity it exudes.
  • Coronary angiographies are performed in conjunction with cardiac catheterization. A special dye that can be seen in X-rays is injected into the patient’s coronary arteries or heart chambers. It aids in the observation of blood flow through the heart and blood vessels with the intent of spotting any abnormal blockages.
  • Echocardiograms are ultrasounds that use sound waves to capture moving images of the heart’s valves and chambers and how they function.

How to treat systolic heart failure

Unfortunately, there’s no permanent cure for this condition, but there are certain systolic heart failure treatment options that can help alleviate and manage some of the symptoms.

Your doctor might recommend making lifestyle changes such as quitting smoking, working to maintain a healthy weight for your body type (whether that means gaining or losing weight), exercising to the best of your ability, and following a strict heart-healthy diet.

Certain medications may also be prescribed to help manage some of the symptoms that are associated with systolic heart dysfunction. These include the following:

  • Digoxin
  • Diuretics
  • Nitrate and hydralazine
  • ACE inhibitors
  • Mineralocorticoid receptor antagonists
  • Beta-blockers

In more severe cases, your doctor might recommend undergoing a surgical procedure to implant certain medical devices like a defibrillator or a left ventricular assist device in your heart to help it pump blood more efficiently and function as normally as possible. A heart transplant could also be necessary depending on the gravity of the situation.

Systolic Vs. Diastolic Heart Failure

There’s a huge difference between systolic and diastolic heart failure. As mentioned, the former means that the blood pumping ventricles in your heart aren’t contracting normally, which can cause a backup of blood flow and lack of sufficient supply to other parts of the body.


Diastolic heart failure, on the other hand, is when your heart muscles don’t relax for a long enough period of time to allow the heart to refill itself with more blood after pumping. As a result, the heart muscles become increasingly stiff and eventually completely lose the ability to relax between heartbeats. Diastolic heart failure occurs when the heart is incapable of replenishing its blood supply during the resting period following each heartbeat.

At the end of the day, you should work closely with your doctor to ensure the quality of your overall health. Be proactive when it comes to matters concerning your health—especially your heart—and always report any abnormalities such as accelerated resting heart rates or difficulties with breathing, as these can be major signs that something is wrong. Your doctor is your ally when it comes to maintaining a healthy and ideal lifestyle and they have the resources to help you identify any potential causes of systolic dysfunction in the heart.

Related: Diastolic heart failure: Causes, symptoms, treatment, and life expectancy


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