EF of 78-88%

[emersushea]

I am a new grad nurse 6 months into my position on a busy cardiac floor. I was always under the impression that an ejection franction (EF) of >55% was good. I was giving report to a fellow nurse and her student, I commented in report that the patient's EF was 78-88% and said "so thats not too bad." The nurse was like "actually thats horrible." But didn't give any rationale. I should have asked her but I was quite embarassed by the manner in which she called it out.

Is it possible to have an EF that is too high? Whats the cause? Or was I right...is an EF of 78-88% ok? I've tried looking it up but all I've found is information about low EF's.

Thanks!

Em

[jmgrn65, RN]

The EF is great. Never heard of a high ef don't know what the other person was thinking.

[glasgow3]

Yep, it's probably bad.....suggests the possibility of hypertrophic cardiomyopathy.

[UM Review RN, ASN, RN]

I am a new grad nurse 6 months into my position on a busy cardiac floor. I was always under the impression that an ejection franction (EF) of >55% was good. I was giving report to a fellow nurse and her student, I commented in report that the patient's EF was 78-88% and said "so thats not too bad." The nurse was like "actually thats horrible." But didn't give any rationale. I should have asked her but I was quite embarassed by the manner in which she called it out.

Is it possible to have an EF that is too high? Whats the cause? Or was I right...is an EF of 78-88% ok? I've tried looking it up but all I've found is information about low EF's.

Thanks!

Em

Same here. Anything over 50% is a good number, from what I was taught. And I know it's not the greatest resource, but WIKI agrees:

http://en.wikipedia.org/wiki/Ejection_fraction

Glasgow, perhaps you could elucidate?

[seanpdent, ADN, BSN, MSN, APRN, NP]

I'm in the middle of this road. I never had an EF that was high referred to as 'bad', but if they pt did have hypertrophic cardiomyopathy .... hhmm would there EF really be that high? Or would it be somewhat norm or lower due to the decreased cardiac output.

hhmm interesting?

[MayisontheWay]

over 75% could mean hypertrophic cardiomyopathy....

(less space available means relatively low volume available thus the heart must pump all it can to maintain cardiac output.)

Very simplistic discription I know! But the nurse was right...higher is not always better!

[SDS_RN, RN]

I remember our CI in school telling us that >60% was good and even possibly as long as it was >40% it could still be okay this info would be from 06' when I graduated. I would say that 78-88% is a good EF.

I looked in both my medsurg and critical care book from school and I could not find a percentage in either of them but I'm pretty sure that your pt's was in an acceptable level. Have you asked on of the nurses you work w/ what norm. paramiters are?

[UM Review RN, ASN, RN]

over 75% could mean hypertrophic cardiomyopathy....

(less space available means relatively low volume available thus the heart must pump all it can to maintain cardiac output.)

very simplistic discription i know! but the nurse was right...higher is not always better!

ok, i admit it. i'm having trouble visualising this. :trc:

could you site a source for the info, please?

this is pretty much what i've learned:

http://www.cvphysiology.com/cardiac%20function/cf012.htm

excerpt:

in heart failure, particularly in dilated cardiomyopathy, ef can become very small as sv decreases and edv increases.

[UM Review RN, ASN, RN]

ok, folks, i think i found it. the pertinent info is boldfaced.

http://www.emedicine.com/ped/topic1102.htm

[color=#333399]imaging studies

• two-dimensional echocardiography reveals lv hypertrophy and is diagnostic for hcm.
  
• • in patients with a systolic gradient, color doppler flow echocardiography typically reveals mitral regurgitation, which may be accompanied by left atrial enlargement.
    
  • spectral continuous wave doppler echocardiography reveals an elevated flow velocity across the lv outflow tract. severe hcm typically has a flow velocity greater than 4.0 m/s, and a gradient greater than 50 mm hg is considered severe.
    
  • echocardiography also typically reveals diastolic dysfunction with reduced lv compliance and a mitral valve e/a ratio less than 1.0 (usually

[UM Review RN, ASN, RN]

I guess the moral of the story is, as always, we have to look at the whole patient picture and all labs and test results are relative.

[MayisontheWay]

OK, a cursory search turned up:

http://www.merck.com/mmpe/sec07/ch074/ch074e.html

Contractility is grossly normal, resulting in a normal ejection fraction (EF). Later, EF is elevated because the ventricle has a small volume and empties nearly completely to maintain cardiac output.

[glasgow3]

I remember our CI in school telling us that >60% was good and even possibly as long as it was >40% it could still be okay this info would be from 06' when I graduated. I would say that 78-88% is a good EF.

I looked in both my medsurg and critical care book from school and I could not find a percentage in either of them but I'm pretty sure that your pt's was in an acceptable level. Have you asked on of the nurses you work w/ what norm. paramiters are?

Don't extrapolate from what your Clinical Instructor actually said. He/she was trying to give you some idea that the low end numbers for EF are not set in cement. That is there is 1) some degree of variability of norms in the literature and 2) there is some degree of variability when trying to measure the EF. That said, I think that most would agree 40% is too low no matter how you slice it. (50% is often described as low normal).

But your main mistake is assuming that if 50% is good then 88% must be better. Most would regard 75% (+/- 5%) as the top end of the normal range, not 100%). As I mentioned in an earlier post, an EF of 88% would start me thinking hypertrophic cardiomyopathy.