Systolic heart failure is left-sided heart failure or left-ventricle heart failure. Systolic heart failure means the heart does not pump efficiently or contract the way it should between heartbeats.

There are two types of left-ventricle heart failure: systolic and diastolic. Both 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 cure.

Read on to learn more about the prevention, diagnosis, and treatment of systolic heart failure.

Systolic heart failure happens when the heart is too weak to circulate blood efficiently throughout the body.

As a result, a person may experience difficulty breathing and retain fluid in the legs or abdomen.

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 blood. It is the fraction of the blood inside the heart that the heart ejects.

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

A lower fraction indicates failure of the left ventricle. Measurements are defined as follows:

  • An ejection fraction of 50–55% is heart failure with preserved ejection fraction.
  • An ejection fraction of 40–49% is heart failure with mildly reduced ejection fraction.
  • An ejection fraction of 40% or less is heart failure with reduced ejection fraction.

Vs. diastolic heart failure

Systolic and diastolic heart failure can occur on 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.

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

Learn more about systolic vs. diastolic heart failure.

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

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

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

Learn about the symptoms of congestive heart failure.

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 considers a person’s physical ability. Stages and symptoms are in the table below:

IThere are no changes to a person’s physical activity.
Their physical activity does not cause tiredness, palpitations, or shortness of breath.
IIThe person feels slightly limited in terms of physical activity.
They are comfortable when at rest.
Their usual physical activity leads to tiredness, palpitations, and shortness of breath.
IIIThe person feels substantially limited in terms of physical activity.
They are comfortable at rest.
Physical activities that should be less tiring than daily tasks cause fatigue, palpitations, or shortness of breath.
IVThe person is unable to carry out any activity without discomfort.
They experience symptoms of heart failure when at rest.
If they try any 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.
There are no symptoms, and the person is not 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 should have a classification that includes both of these staging methods.

According to the National Heart, Lung, and Blood Institute, systolic heart failure can result from:

Hereditary causes

Systolic heart failure can also be hereditary. This means a person may be more prone to the condition if the same health problems have occurred in older family members.

This can make several generations more prone to heart failure due to genetic predisposition.

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 possible causes of an abnormal EKG.

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 the following heart-healthy habits for a person with heart failure:

  • eating less sodium
  • maintaining a moderate weight
  • taking part in regular physical activity, where possible
  • not smoking, if applicable
  • limiting alcohol, if applicable
  • limiting stress, where possible
  • getting quality sleep
  • treating sleep apnea

Learn about a balanced eating plan for heart health.


Medications for systolic heart failure can include:

  • Diuretics: These medications can relieve congestion and improve symptoms. For example, a doctor may prescribe furosemide.
  • Aldo antagonists: These medications interrupt chemical pathways that can damage the heart. A doctor may prescribe spironolactone.
  • Medications that relax blood vessels: These can make it easier for the heart to pump blood and interrupt harmful chemicals to the heart. They may include:
  • Medications that slow the heart rate: These can make it easier for the heart to pump blood and may include:
  • SGLT2 inhibitors: These medications help reduce the risk of death or hospitalization in people with heart failure.
  • Digoxin: This medication 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.

Certain medications, such as diuretics, are for symptom relief. Others can change the outlook of the disease, reduce hospitalizations, and improve disease mortality.


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 procedure involves inserting a pacemaker to ensure the heart beats with the right timing and synchronously.

Another surgical option is an implantable cardiovascular defibrillator. This surgery involves placing an electronic device that monitors and regulates 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 remainder of their life.

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

A 2016 study suggests a 5-year survival rate for those who experience systolic heart failure across all stages. However, more precise mortality rates vary based on stage, symptoms, and heart failure hospitalizations.

One estimate of the survival rate for heart failure is as follows:

  • after 1 year: 80–90%,
  • at 5 years: 50–60%
  • after a decade: 30%

Systolic heart failure is a serious heart condition that can cause severe symptoms, some symptoms, or none at all.

There is currently no cure. However, early diagnosis and treatment of heart failure symptoms may help manage the condition and sometimes improve and normalize the heart’s function.

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

Read this article in Spanish.