Systolic heart failure is a type of left-sided heart failure, otherwise known as left-ventricle heart failure. Systolic heart failure means that the heart does not pump efficiently, and does not contract the way it should between heartbeats.

There are two types of left-ventricle heart failure. These are systolic and diastolic heart failure. Both of these types can eventually lead to right-ventricle heart failure.

However, there are differences between systolic and diastolic heart failure.

Though treatment for systolic heart failure is available, there is no known cure.

Read on to learn more about preventing, diagnosing, and treating systolic heart failure.

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Systolic heart failure happens when the heart beats too weakly to circulate blood throughout the body.

The heart cannot exert enough force to operate as it usually would.

As a result, a person may struggle to get enough oxygen, and may experience difficulty breathing.

Ejection fraction

Systolic heart failure is also called heart failure with reduced ejection fraction.

Ejection fraction measures how well the left part of the heart is pumping out blood. It is the fraction of the blood inside the heart that the heart ejects.

A healthy, normal heart pumps blood at an ejection fraction of 55%–70%.

A lower fraction indicates failure of the left ventricle.

Vs. diastolic heart failure

Systolic and diastolic heart failure can occur in either side of the heart, but this article focuses on heart failure of the left ventricle.

Systolic heart failure means the heart is not strong enough to pump blood out.

Diastolic heart failure means the heart muscle is not relaxing properly between beats.

Learn more about systolic vs. diastolic heart failure here.

Those with systolic heart failure may not notice symptoms until the condition has advanced.

The first symptom a person might notice is that they become unusually out of breath doing everyday tasks.

Other symptoms a person with left-sided heart failure may experience include:

Learn about symptoms of congestive heart failure here.

There are two main ways of classifying heart failure.

According to the American Heart Association, the first is the New York Heart Association (NYHA) Functional Classification, which takes into account a person’s physical ability:

IThere are no changes to their physical activity.
The person’s physical activity does not cause tiredness, palpitations, or shortness of breath.
IIThe person feels slightly limited in terms of physical activity.
The person is comfortable when at rest.
Their normal physical activity leads to tiredness, palpitations, and shortness of breath.
IIIThe person feels substantially limited in terms of physical activity.
The person is comfortable at rest.
Physical activities that should be less tiring than their daily tasks cause fatigue, palpitations, or shortness of breath.
IVThe person is unable to carry out any kind of activity without discomfort.
The person experiences symptoms of heart failure at rest.
If they try any kind of physical activity, their discomfort increases.

The second way of classifying stages of heart failure involves an objective assessment of cardiovascular disease:

StageObjective Assessment
AThe person is at risk for heart failure without objective signs or symptoms of heart failure.
There are no symptoms and the person does not feel limited in their usual physical activities.
BThere is objective evidence of some structural heart disease.
The person is without signs or symptoms of heart failure.
CThere is objective evidence of structural heart disease.
The person has current or prior symptoms of heart failure
DThere is objective evidence of advanced heart failure
The person feels severely limited.
The person experiences symptoms even when they are at rest.

A person can have a classification that includes both of these staging methods.

For example, if a person has no symptoms, but they have an ejection fraction of the heart that is reduced to 40%, they would have the classification “Function Capacity NYHA Class I, Objective Assessment B.”

According to the National Heart, Lung, and Blood Institute, systolic heart failure can have the following causes including:

Hereditary causes

Systolic heart failure can also be hereditary, meaning people may be more prone to the condition if the same health problems have occurred in older members of their family.

Some of the most common causes of heart failure, like diabetes or hypertension, are also hereditary. This can make several generations more prone to heart failure if they inherit these conditions genetically.

If a person is experiencing symptoms of systolic heart failure, doctors may order an echocardiogram for confirmation. This technology will reveal the ejection fraction of the left ventricle.

A doctor may also order other tests to confirm a diagnosis, such as:

Learn about what might cause an abnormal EKG here.

There is no cure for heart failure.

However, with certain treatments and lifestyle changes, symptoms may improve, and the heart may become stronger.

Behavioral changes

A doctor may suggest a person take up the following heart-healthy habits:

  • eating less sodium
  • maintaining a moderate weight
  • partaking in regular physical activity where possible
  • not smoking
  • limiting alcohol intake
  • limiting stress, where possible
  • getting good quality sleep
  • treating sleep apnea

Learn about how to follow a cardiac diet here.


Medications for systolic heart failure can include:

  • Diuretics: These medicines can relieve congestion. For example, a doctor may prescribe furosemide.
  • Aldo antagonists: These medicines interrupt chemical pathways that can be damaging to the heart. A doctor may prescribe spirinolactone.
  • Medicines that relax blood vessels: These medicines can make it easier for the heart to pump blood. They may include:
    • angiotensin converting enzyme inhibitors
    • angiotensin receptor blockers
    • angiotensin neprilysin inhibitors
  • Medicines that slow the heart rate: These medicines can make it easier for the heart to pump blood and may include:
    • beta-blockers
    • ivabradine
  • Digoxin: This medicine can make the heart beat stronger and pump more blood. It can be useful in cases of serious heart failure, when other medicines have not helped.
  • SGLT2 inhibitors: These medicines may help reduce the risk of death or hospitalization in people with heart failure.


In some cases, underlying factors may contribute to systolic heart failure that doctors can deal with surgically.

A doctor may choose cardiac resynchronization therapy. This surgery involves inserting a pacemaker to ensure the heart is beating with the right timing.

Another surgical option is an implantable cardiovascular defibrillator. This surgery involves placing an electronic device that can monitor and regulate the heart.

A doctor may also recommend the following surgeries:

According to the National Heart, Lung, and Blood Institute, a person with heart failure may need to follow a treatment plan for the rest of their life.

Ultimately, their outlook will depend upon the stage of systolic heart failure, and whether the condition is advanced.

A 2016 study suggests that a five-year survival rate is expected for those who experience systolic heart failure across all stages. However, more precise mortality rates vary based on stage.

The survival rate for heart failure is as follows:

  • After 1 year: 80–90%,
  • By the 5th year: 50–60%
  • After a decade: 30%

Systolic heart failure is a serious heart condition that can cause severe symptoms, some symptoms, or no symptoms at all.

There is no known cure at this time. However, early diagnosis and treatment of heart failure symptoms may help manage the condition and sometimes can improve and normalize the function of the heart.

Patients can increase their quality of life and prognosis by talking to a medical professional about an effective treatment plan.

Read this article in Spanish.