Heart failure with reduced ejection fraction (HFrEF, hef-REF) is a form of heart failure in which the ejection fraction is reduced. [1] This is defined as a left ventricular ejection fraction (LVEF) of 40% or less. About half of heart failure patients have a reduced ejection fraction. [2] Other types of heart failure are heart failure with mildly reduced ejection fraction (HFmrEF, LVEF between 40% and 50%) and heart failure with preserved ejection fraction (HFpEF, LVEF 50% or higher). [1] [3]
HFrEF may result in a variety of signs and symptoms, though these are non-specific, so their presence cannot confirm that a person has HFrEF. The most typical symptoms are shortness of breath, orthopnea (shortness of breath when lying flat), paroxysmal nocturnal dyspnea (shortness of breath and coughing at night), fatigue, and reduced exercise tolerance, and ankle swelling (peripheral edema). The most specific signs, those which are most likely to indicate HFrEF as opposed to other conditions, are high jugular venous pressure (often marked by visibly distended jugular veins) and positive abdominojugular test, a third heart sound, and an apex beat farther to the side of the body than normal. [2]