EF of 78-88%

Nurses General Nursing

Published

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

Thanks to the OP for posting the question and to the respondents--I learned a lot on this tread this morning!

Up Vote Up Vote ×

Thanks to all who answered my post! A little more information, because now more questions arise! I am so perplexed by this patient's situation. Sorry for the novel here....

The pt is very young and had an AVR when he was a teen d/t aortic stenosis. Now that valve is failing so he's in CHF but has an EF of 78-88%. With CHF I thought EF was lower? But I suppose with an inefficient valve the cardiac muscle would be working harder and cardiomyopathy could ensue? Could that lead to the increased EF?

So last night I could not for the life of me get his blood pressure up. Baseline BP was 120s/60s not on any meds. Last night his BP was 96/56 so I held his lisinopril but ended up giving him his PO amiodarone. A couple hours later his BP dropped to 86/54, the pt was nonsymptomatic. I attributed this decrease as being from the amio and the fact that the pt had been sleeping. About an hour later the pt woke with 10/10 chest pain. BP was 84/52; I medicated w/ morphine, cutting the dose in half d/t his BP. CP resolved. But BP was still 84/52. I spoke with my charge and contacted the on-call cardiologist who ordered a 250mL NS bolus followed by routine NS @ 100 mL/hr.

I was very fearful of fluid overload d/t CHF but the pt's lungs remained clear, he had a good urine output, he denied SOB/CP, and had no edema. But the bolus and fluids did absolutely nothing to increase his BP. In fact, at one point after the bolus, his SBP dropped to 82 but then returned to 84. So I called the on-call MD again who decided to DC the fluids and just have me hold his AM amio; the latter I was planning on doing anyway. For the rest of the shift he had no CP and his BP remained 84/52. I neglected to mention that the patient had been in sinus rhythm in the low 70s for the entire shift.

I have read that with aortic stenosis a person may suffer from low BP and that there is an increased pressure gradient regarding the aortic valve. Could this be why the fluids didn't effect his BP? Could his high EF be playing a role in all of this? I feel like I did something wrong but I don't know quite what. :confused:

Thanks everyone!

Up Vote Up Vote ×

Another thing the patient had been on 2.5 mg lisinopril bid and 200mg amiodarone qid. His cardiologist upped the lisinopril to 5 mg despite having a SBP in the 90s. I am wondering if the prescribing MD wanted to lower the BP so that the heart would pump more efficiently. I have heard about certain circumstances in which MDs want the BP low enough to cause dizziness in order to make the workload easier on the heart. It would have been nice if she were to include that in her progress notes or med orders!

Up Vote Up Vote ×

Very interesting thread. Lots to know out there, huh? There are so many variables! So it bugs me if someone points something out as if it's something a person could have definitely figured out if they thought it out far enough. When you integrate the symptoms you see in certain types of cases with physio/pathophys, then you can piece together what's happening, but in many cases, when you're unfamiliar with the condition/situation, the best you can do is make an educated guess and then try to look for more evidence from sources with more experience and understanding of the condition/situation.

Up Vote Up Vote ×
Specializes in CCU/CVU/ICU.

Another spin on this....

The EF measures the percentage of blood ejected from the left ventricle....but not WHERE the blood is being ejected to.

With this in mind, sometimes in bad MR (mitral regurge) you will see high EFs...at least early on. Thats because the blood is being ejected both through the AV(aortic valve) AND back through the MV (mitral valve). So...you'll sometimes see these high numbers (which..are NOT necessarily good). The *actual* EF in LVs (left ventricles) like this would be much lower.

Now...as this LV with the bad/leaky MV eventually fails the EF by echocardiography will look more 'normal'...say 50% or so. The bad thing is that much of this blood is going backwards through the MV...so again the*actual* Ef will be much lower.

The definitive treatment for bad MR is (obviously) MV-repair/replacement. After surgery, the EF will many times (usually) drop....again not necessarily a bad thing. However, it may be desirable for the patient to have an 80% EF pre-op (maybe dropping to 50% post-op?) rather than a 50% pre-op (and maybe a 30% post-op?). These numbers may be overly dramatic, but i'm just making a point.

Up Vote Up Vote ×
Specializes in PACU,Geriatrics,ICU.

Does this mean that you just can't just diagnose HCM by EF alone? I would have thought that you have to see other abnormalities on the echo....am I wrong?

Up Vote Up Vote ×
Specializes in neuro, ICU/CCU, tropical medicine.

Treat the patient, not the number.

How does the patient look? Does s/he have edematous feet/ankles? How do the lungs sound - wet? What are the heart sounds - S1-S2, or are there murmurs or gallops? Is s/he ambulatory, or does s/he get short of breath? How's the urine output?

IMO, the answers to these questions will tell you much more about the patient than the EF...

...but what do I know, I'm just an old neuro nurse who doesn't know what a normal EF is in the first place...

...but I know where I can find out.

Up Vote Up Vote ×
Specializes in neuro, ICU/CCU, tropical medicine.
Thanks to all who answered my post! A little more information, because now more questions arise! I am so perplexed by this patient's situation. Sorry for the novel here....

Ooops! I hadn't read this when I put up my last post. I sounds like you're on top of it!

Up Vote Up Vote ×
Specializes in Anesthesia.

Ok, I can't actually be sure, but it sounds like the patient has diastolic CHF. Basically the heart can't relax, and the clinical signs are the same as those with systolic CHF. The difference is that the EF would be normal or possibly elevated. http://www.dcmsonline.org/jax-medicine/2002journals/Feb2002/diastolic.htm

Up Vote Up Vote ×
Specializes in Med/Surg/Tele/Acute Rehab.

Maybe talk to the cardiologist?

Up Vote Up Vote ×
Specializes in CCU/CVU/ICU.
Does this mean that you just can't just diagnose HCM by EF alone?

Yes. You're 100% correct in this statement.

Up Vote Up Vote ×
+ Add a Comment