Heart Disease with Normal Left Ventricular Function: What You Need to Know
When we think of heart disease, we often associate it with a weakened or failing heart muscle. However, it's important to understand that not all heart diseases present with reduced heart pumping function. In fact, many individuals experience significant cardiac symptoms despite having a normal left ventricular (LV) function.
As a leading interventional cardiologist at Paras Hospital, Gurugram, Dr. Madhur Jain often encounters patients confused by normal test reports yet persistent cardiac symptoms. This blog aims to explain why normal LV function does not always mean a healthy heart and what conditions may be hiding beneath the surface.
Understanding Left Ventricular Function
The left ventricle is the main pumping chamber of the heart that circulates oxygen-rich blood to the body. Its function is often assessed using a test called Echocardiography (ECHO) to measure the ejection fraction (EF) — the percentage of blood the heart pumps out with each beat. A normal EF ranges from 50% to 70%.
When patients are told their EF is normal, they often assume their heart is in perfect health. However, EF alone does not give the complete picture.
Can You Have Heart Disease with Normal LV Function
Yes. There are multiple heart conditions that can occur even when the pumping function of the heart is preserved. These include:
Diastolic Dysfunction (Heart Failure with Preserved Ejection Fraction - HFpEF)
- The heart relaxes poorly and doesn’t fill properly.
- Symptoms: breathlessness, fatigue, swelling, especially in older adults or those with high blood pressure or diabetes.
Coronary Artery Disease (CAD)
- Blockages in the coronary arteries can cause chest pain (angina) or heart attacks even when EF is normal.
- A stress test or angiography may be needed for diagnosis.
Microvascular Angina (Cardiac Syndrome X)
- Chest pain caused by small vessel disease not seen on routine angiography.
- More common in women and may mimic classic angina.
Valvular Heart Disease
- Conditions like mitral valve prolapse or aortic stenosis may not immediately affect EF.
- Can still lead to symptoms like palpitations, breathlessness, or fatigue.
Pericardial Diseases
- Inflammation or thickening of the heart’s outer lining can restrict function.
- Symptoms may include chest discomfort, breathlessness, or low blood pressure.
Arrhythmias
- Abnormal heart rhythms (like atrial fibrillation or ventricular ectopy) can cause palpitations or dizziness, despite a normal EF.
Pulmonary Hypertension
- High pressure in the lungs' blood vessels affects heart performance.
- Often missed unless specifically evaluated.
Key Investigations Beyond Ejection Fraction
To assess overall cardiac health, Dr. Madhur Jain may recommend additional investigations such as:
- Stress Test or TMT
- Coronary Angiography or CT Coronary Angiogram
- Cardiac MRI
- 24-hour Holter Monitoring
- BNP/NT-proBNP blood tests for heart failure
- Right heart catheterization (in specific cases)
Dr. Madhur Jain’s Holistic Approach to Diagnosis
At Paras Hospital, Gurugram, Dr. Madhur Jain emphasizes that a normal echo doesn't always mean a normal heart. His patient-first approach includes:
- A detailed clinical history
- Personalised risk assessment
- Advanced cardiac imaging and diagnostics
- Lifestyle and medication-based treatment tailored to the underlying cause
His extensive expertise in handling complex cardiac conditions, including those with normal EF, ensures that no warning signs are missed.
When to See a Cardiologist Even If Your EF is Normal
If you experience:
- Unexplained chest pain or tightness
- Shortness of breath on exertion
- Dizziness or fainting spells
- Persistent fatigue or swelling in the legs
- Palpitations or irregular heartbeats
Don't ignore it. Schedule an evaluation even if your previous heart test results were “normal.”
Conclusion
A normal left ventricular function is reassuring, but it doesn't rule out heart disease. If you're experiencing symptoms or have risk factors like diabetes, hypertension, smoking, or a family history of heart disease, consult a trusted cardiologist like Dr. Madhur Jain for a deeper evaluation.
Remember: Heart health is more than just a number — it's about understanding the whole picture.