Systolic congestive heart failure, also called systolic heart failure, is a form of heart failure that primarily affects the left side of the heart. When the left ventricle loses its ability to contract properly, it can no longer pump blood with enough force to circulate efficiently throughout the body.

This condition is identified when the heart’s ejection fraction—the percentage of blood pumped with each heartbeat—drops to 40% or lower. It is often referred to as heart failure with reduced ejection fraction (HFrEF).

In the United States, an estimated 6.5 million people have heart failure, with about half of those cases being HFrEF. The risk of developing systolic heart failure increases with age.

Systolic Heart Failure Symptoms

Symptoms may appear suddenly but typically develop gradually. In the early stages, symptoms may only arise during physical exertion, but over time, they can appear even at rest.

Common Symptoms

  • Rapid or irregular heartbeat

  • Heart palpitations

  • Shortness of breath, especially when lying down or during the night

  • Wheezing

  • Persistent cough

  • Unexplained weight gain

  • Abdominal swelling from fluid buildup

  • Leg or scrotal swelling

  • Enlarged neck veins

  • Loss of appetite

  • Mental confusion

What Causes Systolic Congestive Heart Failure?

Systolic heart failure occurs when the left ventricle becomes enlarged and weakened. The two leading causes are coronary artery disease and chronic high blood pressure.

Heart-Related Causes

  • Coronary artery disease: Narrowed or blocked arteries reduce oxygen supply to the heart.

  • High blood pressure: Forces the heart to work harder, weakening the heart muscle.

  • Congenital heart defects: Structural abnormalities from birth can contribute over time.

  • Heart attacks: Damage the heart muscle through sudden loss of blood flow.

  • Valve disorders: Poorly functioning valves reduce effective blood flow.

  • Infections: Viral infections, including flu or COVID-19, can damage the heart.

  • Arrhythmias: Irregular heart rhythms impair the heart’s efficiency.

Non-Cardiac Causes

  • Type 2 diabetes: Chronic high blood sugar can damage blood vessels, including those of the heart.

  • Metabolic syndrome: A combination of risk factors including high blood pressure and abnormal cholesterol.

  • Hyperthyroidism: Excess thyroid hormones can accelerate heart rate and stress the heart.

Risk Factors

  • Smoking

  • Alcohol or drug misuse

  • Obesity or excess body weight

Diagnosis

Healthcare providers diagnose systolic heart failure through a combination of medical history, physical examinations, and diagnostic tests.

Diagnostic Tests

  • Electrocardiogram (EKG/ECG): Detects irregular rhythms or signs of a heart attack.

  • Chest X-ray: Identifies fluid in the lungs or an enlarged heart.

  • Echocardiogram: Measures heart structure and ejection fraction.

  • Exercise stress test: Evaluates heart function during physical exertion.

  • Left heart catheterization: Provides imaging of coronary arteries and evaluates heart performance.

  • Blood tests: BNP levels are often elevated in heart failure.

  • Other imaging: CT scans, MRI, and nuclear imaging may support diagnosis.

Treatment Options

Treatment focuses on managing symptoms, improving heart function, and addressing underlying causes. Cardiologists may recommend a combination of the following approaches:

Medications

  • ACE inhibitors: Lower blood pressure and improve circulation.

  • Angiotensin receptor blockers (ARBs): Block effects of angiotensin-2 to relax blood vessels.

  • Beta-blockers: Slow the heart rate and improve pumping efficiency.

  • Diuretics: Help reduce fluid buildup.

  • SGLT2 inhibitors: Lower risk of death and hospitalization in HFrEF patients.

Medical Devices

  • Implantable cardioverter-defibrillator (ICD): Detects and corrects dangerous arrhythmias.

  • Ventricular assist devices (VADs): Mechanical pumps that support heart function in advanced heart failure.

Surgical Procedures

  • Coronary revascularization (bypass surgery): Restores blood flow to blocked arteries.

  • Heart transplant: May be needed in severe cases when other treatments fail.

Lifestyle Modifications

Changes in daily habits can play a significant role in managing heart failure.

  • Reduce salt intake: Helps minimize fluid retention.

  • Maintain healthy weight: Lowers stress on the heart.

  • Stay active: Exercise helps control blood pressure and cholesterol.

  • Avoid smoking: Reduces further heart damage.

  • Limit alcohol: Prevents additional strain on the heart.

  • Manage stress: Use techniques such as therapy or relaxation.

  • Sleep well: Aim for 7–9 hours and treat any sleep disorders.

Prevention

Preventing systolic heart failure involves adopting heart-friendly practices.

  • Heart-healthy diet: Low in salt and saturated fat, rich in fruits, vegetables, and whole grains.

  • Regular exercise: At least 30 minutes of moderate activity daily.

  • Stress reduction: Engage in enjoyable, calming activities.

  • Avoid smoking: Smoking significantly raises the risk of heart disease.

  • Routine check-ups: Monitor blood pressure, cholesterol, and blood sugar to catch issues early.

Related Conditions

People with systolic heart failure may also face related health complications.

Chronic Obstructive Pulmonary Disease (COPD)

This lung disease often coexists with heart failure and shares symptoms such as breathlessness.

Liver Damage

Reduced circulation and fluid retention can lead to liver scarring (cirrhosis).

Kidney Damage

Lower blood flow from heart failure can impair kidney function.

Other Heart Conditions

Includes pulmonary hypertension, arrhythmia, valve disease, and risk of cardiac arrest.

Living With Systolic Heart Failure

Managing HFrEF involves consistent medical care and lifestyle adherence. The condition may worsen due to infections, high salt intake, or cardiac events like a heart attack.

Life expectancy varies based on the severity and the patient’s overall health. Because HFrEF tends to have a more serious prognosis than other forms of heart failure, close monitoring—especially of ejection fraction—is crucial for long-term outcomes.