What is a normal ejection fraction at age 65?

According to the American Heart Association, a normal ejection fraction falls between 55% and 70% for most adults, including those who are 65 and older. While a person's heart function can change with age, this standard range provides a general benchmark for assessing cardiac performance.

Quick Summary

A normal ejection fraction (EF) for a 65-year-old is typically between 55% and 70%, reflecting the heart's ability to pump blood. However, a normal EF does not automatically rule out heart failure, a condition known as heart failure with preserved ejection fraction (HFpEF), which is more common in older adults.

Key Points

• Normal Range: A normal ejection fraction (EF) for a 65-year-old is between 55% and 70%, similar to other age groups.

• Normal EF Doesn't Guarantee No Heart Failure: In older adults, a normal EF can coexist with symptoms of heart failure, a condition called HFpEF.

• Age-Related Changes and Comorbidities Matter: EF can be influenced by age-related stiffening and conditions like high blood pressure, diabetes, and CAD, which are more common in seniors.

• Diagnosis Beyond the Number: Diagnosing heart conditions in seniors requires looking beyond the EF percentage, integrating clinical symptoms, and considering other test results.

• Lifestyle is Key: Maintaining a heart-healthy diet, regular exercise, managing weight, and monitoring stress are crucial for supporting heart function at age 65 and beyond.

• Measurement Methods: EF is most commonly measured via a painless echocardiogram, but other imaging tests like cardiac MRI are also used.

Understanding Ejection Fraction (EF)

Ejection fraction is a crucial measurement indicating the percentage of blood pumped out of the left ventricle with each heartbeat. This metric is vital for assessing cardiac health, particularly as you age.

The Normal Range at Age 65

A normal left ventricular ejection fraction (LVEF) for adults, including those around 65, is generally 55% to 70%. While aging itself doesn't alter this range, age-related factors and comorbidities can impact heart function. Doctors use this range as a guide, considering individual health profiles.

What EF Scores Mean

Interpreting EF involves understanding what different ranges signify:

• Normal (55–70%): Efficient heart function, but doesn't exclude conditions like HFpEF in older adults.
• Borderline (50–54%): May warrant further monitoring or suggest early heart damage.
• Mildly Reduced (41–49%): Can indicate developing heart failure or cardiomyopathy, requiring further tests.
• Reduced (40% or lower): A strong sign of heart failure or cardiomyopathy, often needing significant medical care.
• High (Above 75%): May point to hypertrophic cardiomyopathy, affecting heart filling.

Ejection Fraction and Heart Failure with Preserved EF (HFpEF)

HFpEF, common in older adults, occurs when the heart stiffens, impairing filling even with a normal EF. Symptoms mimic heart failure, often linked to conditions like hypertension and diabetes. Diagnosis requires a comprehensive evaluation.

Measuring Ejection Fraction

EF is typically measured non-invasively. The most common method is an echocardiogram, using sound waves to image the heart. Other methods include:

• Cardiac MRI: Highly accurate, providing detailed images.
• Cardiac CT: Uses X-rays for cross-sectional views.
• Nuclear Medicine Scan: Tracks blood flow with a radioactive tracer.

Factors Influencing EF in Older Adults

Several factors prevalent in older adults can affect EF:

• Comorbidities: Conditions like hypertension, diabetes, CAD, and atrial fibrillation are common and impact EF.
• Arterial Stiffening: Age-related stiffening increases the heart's workload.
• Systemic Inflammation: Higher inflammation levels in older adults can harm heart function.
• Sedentary Lifestyle: Lack of activity can lead to decreased heart function.
• Medications: Some medications can influence heart function and EF readings.

A Comparison of HFrEF vs. HFpEF

Feature	Heart Failure with Reduced Ejection Fraction (HFrEF)	Heart Failure with Preserved Ejection Fraction (HFpEF)
Ejection Fraction (EF)	Less than 40% (Reduced)	50% or higher (Normal)
Underlying Problem	Left ventricle has trouble pumping blood out	Left ventricle has trouble filling with blood
Primary Cause	Often results from damage after a heart attack	Often linked to age, high blood pressure, diabetes
Associated Symptoms	Fatigue, shortness of breath, swelling	Fatigue, shortness of breath, swelling (paradoxical)
Prevalence	Less common in elderly than HFpEF	Most common type of heart failure in elderly

Healthy Lifestyle for Heart Health at Age 65 and Beyond

Prioritizing heart health through lifestyle choices is essential for seniors. These habits can support cardiac function and reduce disease risk:

1. Heart-Healthy Diet: Emphasize fruits, vegetables, whole grains, and lean protein, limiting unhealthy fats and sodium.
2. Regular Exercise: Aim for at least 150 minutes of moderate aerobic activity weekly to strengthen the heart.
3. Weight Management: Maintaining a healthy weight reduces heart strain.
4. Regular Monitoring: Get check-ups to track blood pressure, cholesterol, and blood sugar.
5. Stress Control: Manage stress through relaxation techniques.
6. Quit Smoking: Smoking significantly harms heart health.
7. Limit Alcohol: Excessive alcohol can weaken the heart.
8. Prioritize Sleep: Aim for 7-9 hours of quality sleep for overall health.

Conclusion

While a normal ejection fraction for a 65-year-old is typically 55% to 70%, the presence of HFpEF means symptoms can occur even with a normal EF. Age-related changes and common comorbidities play a significant role. A heart-healthy lifestyle and regular medical care are vital for senior cardiovascular health. Always consult a healthcare professional for personalized EF assessment and guidance. For more information, visit the American Heart Association.

Frequently Asked Questions

What is the primary cause of a reduced ejection fraction in seniors?

A reduced ejection fraction (below 50%) is most often caused by a weakened heart muscle, which can be the result of a past heart attack, coronary artery disease, high blood pressure, or cardiomyopathy.

Can an ejection fraction of 65 be considered a sign of heart problems?

An EF of 65% is within the normal range. However, it is possible to have a normal EF and still experience heart failure symptoms, a condition known as HFpEF. A doctor will evaluate all symptoms and test results to make a diagnosis.

How does an echocardiogram measure ejection fraction?

An echocardiogram uses high-frequency sound waves to create moving images of your heart. Specialists can measure the volume of blood in the left ventricle before and after a beat to calculate the EF percentage.

What is the difference between diastolic and systolic heart failure in the context of ejection fraction?

In systolic heart failure (HFrEF), the heart muscle is weakened and has a reduced EF (less than 40%). In diastolic heart failure (HFpEF), the heart muscle is stiff, impairing its filling ability, but the EF is preserved (50% or higher).

Can lifestyle changes improve a low ejection fraction at age 65?

Yes, lifestyle modifications, along with medical treatment, can improve EF. Regular exercise, a heart-healthy diet low in salt, quitting smoking, and maintaining a healthy weight are all important steps.

What are the symptoms of a low ejection fraction in an elderly person?

Symptoms can include fatigue, shortness of breath (especially with exertion), swelling in the legs and feet, and a rapid or irregular heartbeat. Many of these symptoms overlap with other conditions, so proper diagnosis is crucial.

Does EF naturally decrease with age?

While the normal EF range does not change, age-related factors like increased arterial stiffness and comorbidities can contribute to a decline in heart function over time. However, a significant decrease is typically linked to an underlying condition, not just normal aging.

Should I be concerned if my EF is 75% or higher?

An EF above 75% can sometimes indicate a heart condition called hypertrophic cardiomyopathy, where the heart's walls are thickened. This condition can affect the heart's ability to fill with blood. A physician would need to conduct a full evaluation.