Home Heart Systolic Heart Failure: Symptoms, Causes, Diagnosis, Treatment & Prevention

Systolic Heart Failure: Symptoms, Causes, Diagnosis, Treatment & Prevention

by Dr. Joe Morales

Systolic heart failure when defined in the simplest term refers to the inability of the heart to supply or transport the metabolic requirements of the tissues in the body. 

Systolic heart failure is a left-sided heart failure, also known as left ventricular heart failure. It means that the heart is not able to pump blood efficiently as it normally does and does not contract between the heartbeats the way it should causing this condition. 

There are two different categories of left ventricular heart failure. These two are systolic and diabolic heart failure. Both these types may eventually cause the right-ventricular failure of the heart. 

However, both may lead to right ventricular failure but conditions are different. Though there are few treatments for systolic heart failure, the cure is still not known. 

Here is a brief guide about systolic heart failure causes, symptoms, diagnosis, treatment, and prevention that you must find out to know more!

systolic haert failure

Systolic heart failure – Overview

You already know by now what systolic heart failure is in simple words. It occurs when your heart starts beating too weakly. When the heart beats weekly it is understood that it’s not able to meet its requirements and circulate blood throughout the body as it should. The heart cannot function efficiently and can’t exert force to pump the blood. As a result of this, the person starts struggling to get enough oxygen and starts feeling difficulty in breathing. 

Systolic heart failure is also known as heart failure with reduced ejection fraction. 

For those of you who are not familiar with ejection fraction, it measures how well the left portion of your heart is pumping the blood out. It is a fraction of the blood present inside the heart which the heart has to eject. The normal and healthy heart usually pumps blood as an ejection fraction of 55 to 70%. When the fraction becomes lower, it refers to the failure of your left ventricle. 

Another type of heart failure which was associated with left ventricular heart failure was diastolic heart failure. Let’s see how it differs from systolic heart failure. 


Diastolic and systolic heart failure may occur on either side of the heart. Systolic heart failure as you already know means that the heart is not able to perform well and pump the blood out or it is not strong enough to do so. Whereas diastolic heart failure refers to the inability of heart muscles to relax between the heartbeats. 

Systolic heart failure- Symptoms 

People having systolic heart failure might not notice the condition or feel the symptoms until their condition reaches an advanced stage. The first symptom that a person having systolic heart failure notices is that they start becoming out of breath suddenly after performing everyday tasks which were normally easy for a person to carry out without shortening of breath. 

Some other symptoms that are noticed when a person has systolic heart failure include the following: 

  • Fatigue (even after having rest)
  • Cough
  • General weakness
  • Bluish fingers (the blood was not pumped to this region appropriately)
  • Bluish lips
  • Difficulty in concentrating
  • Sleepiness
  • Difficulty sleeping when you lie flat.
  • Swelling or gaining weight. 

Systolic heart failure- Classification 


There are two different ways you can classify heart failures. As per American Heart Association, the first way of classifying is NYHA (New York Heart Association). This type issues a person’s physical ability and involves 4 stages of systolic heart failure. 

Let’s go through all the stages and see what their symptoms are. 

  1. Stage one- During this stage you will not notice any symptoms and changes to physical activities. There will be no tiredness, shortness of breath, or palpitations after physical activities even after having heart failure. 
  2. Stage two- In this stage, the person feels limited in terms of activities but slightly. They are more comfortable when resting and their normal physical activities or day-to-day activities lead to palpitations, shortness of breath, and tiredness. 
  3. Stage three- Reaching this stage the person starts feeling limited substantially in terms of physical activity. They are more comfortable resting and certain physical activities that must be less tiring start causing fatigue, shortness of breath, and palpitations. 
  4. Stage four- When it comes to stage four, the person is not able to perform any kind of activity without a lot of discomforts. They start experiencing heart failure even when theta is resting. Doing any sort of activity increases the discomfort they are going through. 

The second way through which systolic heart failure is classified is through objective assessment of cardiovascular disease. Let’s see the stages involved with objective assessment. 

  1. Stage A- In this stage, the person is at heart failure risk without objective symptoms or signs of heart failure. There are no symptoms at all so the person feels completely fine in performing tasks. 
  2. Stage B- At this stage, there is objective evidence of structural heart diseases. But there are no symptoms and signs of heart failure yet. 
  3. Stage c- Reaching this stage, there is objective evidence of diseases and the person starts seeing symptoms of heart failure. 
  4. Stage D- This is the final stage. There is objective evidence of advanced heart failure and the person starts feeling severely limited. Even at rest, they feel the symptoms. 

When a person visits for diagnosis, they are informed more about these stages and written in their reports about the stage they are in. 

Both the classifications are sometimes used to refer to a stage. For instance, if the person has not yet seen any of the symptoms but still has an ejection fraction of the heart reduced to 40%, the classification would be “function capacity NYHA class I with objective assessment B”. 

Now that you know the different symptoms and classification of systolic heart failure, let’s see what causes this condition in the first place. 

Systolic Heart failure- Causes 

According to the National heart institute, the causes of systolic heart failure can be any of the following: 

  1. A blood clot in the lungs. 
  2. Heart valves becoming faulty. 
  3. Irregular heartbeat. 
  4. Blockages or heart attacks in the blood vessels. 
  5. Coronary heart diseases. 

These were some other health conditions or diseases that lead to systolic heart failure but systolic heart failure could be hereditary as well. If any similar condition has occurred in their older family members, it can be passed to the younger generations. Some of the most common causes like hypertension and diabetes are also hereditary and both are known to be associated with heart failure. If a person inherits conditions like diabetes and hypertension genetically, they are at more risk of developing heart failure. 

After seeing the causes and all possible symptoms, let’s see how one can get the condition diagnosed so that it can be treated in the early stages. 

Diagnosis of systolic heart failure 

If anyone is exercising systolic heart failure symptoms, the doctors or healthcare experts order an echocardiogram to confirm it. This is a technology that helps reveal the ejection fraction value of the left ventricle. There are some other tests also that the doctors may order for a diagnosis of heart failure, such as:

  • Blood tests
  • Stress Test
  • Event or Holter monitor
  • EKG or electrocardiogram
  • Coronary angiography
  • Cardiac catheterization
  • Nuclear heart scan
  • MRI scan
  • Coronary CT scan
  • X-ray of chest

There are so many ways through which it can be diagnosed easily by doctors. After the diagnosis, the doctors can find the cause and provide treatment accordingly. Know, that there is still no cure for systolic heart failure but treatment options can help manage the symptoms. 

Treatment for systolic heart failure 

As mentioned above, there is no known cure for heart failure yet. However, using certain treatment options and lifestyle changes, a person can improve their heart’s health and reduce the symptoms. Let’s see all the treatment options and lifestyle changes that need to be done. 


Medications are present for systolic heart failure and they include the following: 

  1. Diuretics– these are medications that help relieve congestion. Furosemide is a well-known diuretic that doctors prescribe after seeing the patient’s condition. 
  2. Aldo antagonists– These medications function by interrupting the chemical pathway that damages the heart. Spironolactone is a type of Aldo antagonist that doctors prescribe after studying the condition carefully. 
  3. Medications to relax the blood vessels– These are certain medications that make it easy for the heart to pump blood thus improving the function. They include angiotensin neprilysin inhibitors, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors. 
  4. Medicines to slow down the heart rate– These medications make it easier for the heart to pump blood throughout the tissues and include Ivabradine and beta-blockers. 
  5. Digoxin- This medicine makes your heartbeat stronger thus pumps blood in more quantity. This is useful when all other medicines have failed to work in severe heart failures. 
  6. SGLT2 inhibitors– These medications help reduce the risk of hospitalization and death in people suffering from systolic heart failure. 


In some cases, underlying factors also operate to systolic heart failure that requires surgery. The doctors may go for cardiac resynchronization therapy for this purpose. This surgery involves using a pacemaker which is inserted to make sure the heart is beating at the right timing. 

Another surgical treatment is using an implantable cardiovascular defibrillator. This involves planting an electronic device that helps regulate and monitor the heart rate. 

Some more surgeries that the doctors may recommend using include: 

  • Coronary bypass surgery. 
  • Heart valve replacement or repair.
  • Heart transplants

Behavioral changes 

Changing your lifestyle and certain habits can also help to improve your heart’s health overall thus leading to healthy heart function. These are some habits you can introduce or changes you can make to your lifestyle.

  • Eat less sodium. 
  • Get a good quality sleep
  • Limit stress wherever possible
  • Limit alcohol intake
  • Do not smoke
  • Involve in regular physical activities when possible.
  • Maintain a moderate weight

After following all these steps and making healthy lifestyle changes, one can improve their heart’s health. A study from 2016 indicates that a five-year survival rate is expected for people experiencing systolic heart failure across all 4 stages. The mortality rate however varies based on the stages. 

The rate of survival for heart failure is: 

  • After 1 year the rate is 80 to 90%.
  • By the end of the 5th year, the rate is 50 to 60%.
  • After 10 years or a decade, the rate becomes 30%.


One can prevent systolic heart failure by making lifestyle changes. Regular physical activities include working out 5 days a week and maintaining a healthy body weight. These are two key steps to reduce the risk. Other healthy habits like eating vegetables and fruits, not smoking, drinking moderately, maintaining a healthy diet, etc can contribute to reducing the risk of systolic heart failure. 

Know that hypertension is one of the major causes that leads to systolic heart failure. Reducing the risk of hypertension automatically reduces heart file risk. 


Systolic heart failure is a serious condition that can cause some symptoms, no symptoms at all, or severe symptoms in people having it. The symptoms are totally based on the stage. 

There is no cure yet for heart failure. However, early diagnosis and early treatment can help manage the signs and symptoms. Sometimes it also helps to improve the function of the heart with healthy lifestyle changes. 

Patients should work on increasing their quality of life and prognosis by talking to professionals about a useful treatment plan. 

This was everything about Systolic heart failure causes, symptoms, treatment options, and prevention. 


  1. https://www.nhlbi.nih.gov/health-topics/heart-failure
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932891/
  3. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cardiac-resynchronization-therapy
  4. https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure#:~:text=Heart%20failure%20with%20reduced%20ejection,push%20enough%20blood%20into%20circulation

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