What To Do After a Low Ejection Fraction Result

What does my ejection fraction number actually mean?

Your ejection fraction (EF) is the percentage of blood your left ventricle pumps out with each beat. Normal is 50–70%. An EF around 40% or below indicates heart failure or significantly reduced function. Dr. Jeremy London calls EF a 'report card and crystal ball' — it grades your current heart function and forecasts future risk. At an EF below 40%, there's roughly a 40–50% increase in 5-year all-cause mortality, often before symptoms appear. That's precisely why a low number is a call to act, not to panic.

If your result sits at 45%, you're at the low end of normal, approaching the heart failure threshold. Dr. London would call this a 'crystal ball moment' — the ideal time to intervene while reversal is most achievable.

How do I find out why my EF is low?

Map your result to the five root cause categories. First, direct muscle damage — a prior heart attack, viral myocarditis, autoimmune disease, or chemotherapy. Second, pressure overload — chronic high blood pressure or aortic stenosis forcing the ventricle to thicken. Third, volume overload — a leaking valve distending the heart. Fourth, rhythm disturbances — atrial fibrillation reducing pumping efficiency. Fifth, lifestyle factors — sedentary behaviour, poor metabolic health, or chronic alcohol.

Your echocardiogram plus your medical history reveals which apply. Multiple categories can coexist — note them all, because each drives a different part of your plan.

Should I verify the result first?

Yes. Confirm your current EF with a repeat echocardiogram and assess for wall motion abnormalities (which indicate scar) and valve function. A single reading can be affected by measurement variability, and your treating cardiologist needs an accurate baseline before designing interventions. This step also determines whether structural issues — blockages, leaking valves, or rhythm problems — need parallel medical treatment.

Do I need medication, surgery, or lifestyle changes?

Often all three, sequenced correctly. Dr. London's implied approach is to institute lifestyle modifications as the foundation, then layer medications as the next step. But if your echo reveals arterial blockages, valve abnormalities, or serious rhythm issues, medical intervention may be needed in parallel — revascularisation (stent or bypass) for blockages, valve repair or replacement for damaged valves, rhythm management for atrial fibrillation, and medications for heart failure under your cardiologist's direction. Medical care runs alongside lifestyle change, not instead of it.

How do I start exercising safely with a low EF?

Ramp much more carefully than a healthy person would. Get medical clearance, and consider entering through a supervised cardiac rehab program — especially if your low EF stems from a heart attack. From there, gradually build toward the Lavine Protocol structure: 4–5 aerobic sessions weekly, one high-intensity, one to two recovery days. Support it with a whole foods diet, blood pressure control, weight management, and strength training to protect muscle. Monitor VO2 max improvement and repeat your echocardiogram at 6–12 months.

Next step

Ask your cardiologist to confirm your EF with a repeat echocardiogram and to identify your root cause categories. Then request a referral to cardiac rehab or medical clearance to begin a carefully ramped aerobic program. A low EF is a starting point, not a verdict — the evidence shows sustained lifestyle intervention can meaningfully improve heart function.