What Is Ejection Fraction (EF)?

Ejection fraction is a measurement of heart failure. Ejection fraction is the percentage of blood that is pumped out with each heartbeat. The heart never empties all of the blood from the lower chambers, called ventricles. A normal ejection fraction in a person at rest is typically between 55 and 70 percent. If the heart muscle has been damaged by a heart attack, or heart muscle disease, the EF may be below normal.

Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD) is another form of atherosclerosis, the hardening and narrowing of the arteries caused by the gradual buildup of fatty deposits and other substances, which restrict the flow of blood. PAD includes all disorders that affect the arteries outside the heart, such as deep vein thrombosis, which is a blood clot that forms in a vein inside the body. The most common form of PAD affects the legs and feet.

Risk Factors

The main risk factor for PAD is smoking. Other risk factors are nearly identical to those for other cardiovascular diseases, including high blood pressure, diabetes, high cholesterol, older age, and atherosclerosis in other arteries. Those with clogged arteries often have similarly damaged blood vessels in other parts of their bodies, which put them at a higher risk for heart attack and stroke.


Some people with PAD have no symptoms, particularly in the early stages. About one-third of patients report pain in their legs while they walk that goes away at rest. Due to the lack of symptoms—or the tendency to think symptoms are part of normal aging or arthritis—PAD may go undiagnosed.

Among those who have early-stage symptoms, the most common are cramping, hair loss on the feet or legs; cold legs or feet; fatigue; changes in leg color; heaviness, pain, or discomfort in the thighs, calves, buttocks, or hips during activity; and changes in toenails. The more the muscles demand from the bloodstream during intense physical activities, the worse the pain.

Diagnosis and Treatment

Physical exams and imaging tests are used to diagnose PAD. Treatments include lifestyle changes (e.g., smoking cessation and exercise), medicines to control cholesterol or blood clots, stents to open blocked arteries, and graft bypass surgery to go around blocked arteries.

Heart Arrhythmias

Heart issues are not only structural; they can be electrical as well. An electrophysiologist tests the heart’s electrical activity and pinpoints the cause of abnormal heartbeats.

Atrial Fibrillation

Atrial fibrillation (AFib) is the most common abnormal heart rhythm. If you’ve been diagnosed with AFib—an irregular, unusually rapid heartbeat affecting the body’s blood flow—you have some company: More than 2.3 million Americans live full and active lives with this condition. The main risks of patients with AFib alone (and no other underlying heart issues) are stroke and heart failure. Many AFib patients take a blood thinner medication to decrease the risk of stroke.

Risk Factors

Several conditions and circumstances are major risk factors for AFib:

  • Increased age (although half of those with AFib are under age 75)
  • Any heart disease, including valve conditions and defects, previous heart attacks, or heart surgery
  • Uncontrolled high blood pressure

Other conditions, such as thyroid problems, sleep apnea, obesity, diabetes, and lung disease can raise the risk of AFib. Drinking alcohol—especially large amounts—can trigger AFib in some people. Genetic factors in AFib are not well known.


Some of us with AFib have no symptoms. Those who do may experience mild fatigue or weakness, difficulty breathing or shortness of breath, heart palpitations (a racing or uncomfortable flopping of the heart), lower blood pressure, lightheadedness, confusion, and chest pain. For some, AFib comes and goes; for others, it’s a chronic condition.

Diagnosis and Treatment

To diagnose AFib, your doctor may order one or more of the following tests:

  • Electrocardiogram (ECG or EKG) – Measures the heart’s electrical activity
  • Echocardiogram – Like a heart sonogram, this can be conducted at rest or while exercising (i.e., a stress echo)
  • Holter/event monitor – Portable ECG machines worn to record heart activity
  • Blood tests – These determine if substances in the bloodstream are affecting your heart’s rhythm or if you have an overactive thyroid gland
  • Chest x-ray – This can assess if problems other than AFib are causing irregular rhythms