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Systolic heart failure is a condition in which the heart doesn’t pump normally. If your left ventricle doesn’t contract well enough, you may have systolic heart failure.

Symptoms of systolic heart failure include fatigue, shortness of breath, weight gain, and coughing.

There are a few other types of heart failure. Diastolic heart failure is when the left ventricle doesn’t relax normally. Right ventricular heart failure is when the deoxygenated side doesn’t contract normally.

If you’ve been diagnosed with systolic heart failure, you likely have a lot of questions about the condition and how it’s treated. Read on for answers to commonly asked questions, and consider using these points as a guide to start discussions with your doctor.

Systolic heart failure needs to be treated with several types of medication. The goal of therapy for this type of heart failure is to reduce the burden on the heart and interrupt the chemicals that can lead to weakening of the heart over time. In turn, your heart should work more efficiently and improve your quality of life.

Medications include:


This type of medication is useful for slowing heart rate, reducing blood pressure, decreasing the force with which the heart contracts, and even reversing heart damage. These medications work by blocking beta receptors, which can be stimulated by epinephrine or norepinephrine.

Angiotensin converting enzyme (ACE) inhibitors

Angiotensin is a hormone produced by your body. It stabilizes circulation by narrowing blood vessels. This raises your blood pressure.

When you have a healthy heart, angiotensin helps to make sure your blood pressure doesn’t get too low. When you have heart failure, angiotensin regulation is disturbed and levels can be excessive.

With systolic heart failure, lowering your blood pressure can reduce the burden on your heart. ACE inhibitors interrupt angiotensin converting enzyme, which relaxes blood vessels and reduces fluid retention. This lowers your blood pressure and rests your heart, so your heart doesn’t have to work as hard to circulate your blood.

Angiotensin II receptor blockers

This medication, often shortened to “ARB,” has very similar benefits to ACE inhibitors as it works on the same pathway. If you can’t tolerate ACE inhibitors because of a reaction such as a cough or swelling, your doctor may prescribe angiotensin II receptor blockers instead. ACE inhibitors and angiotensin II receptor blockers are not used together.

Angiotensin receptor-neprilysin inhibitors

This type of combination medication, referred to as “ARNi” for short, pairs an angiotensin receptor blocker with a neprilysin inhibitor. In some people, this kind of combination treatment can be the most effective option.

An example of this type of medication is a treatment that combines valsartan and sacubitril (Entresto). It works to widen blood vessels, while also reducing excess fluid in the body.


Commonly known as water pills, this medication helps to prevent excess fluid buildup in your body. You may have increased thirst and urination.

Potential benefits include easier breathing and reduced bloating or swelling. These medications are given for symptom relief only and do not help you live longer or change the course of the disease.

Aldosterone antagonists

This medication also works on the stress hormone system that is activated in heart failure. It’s usually part of the combination of medications used to treat systolic heart failure.

In addition, this medication can cause high potassium levels. You may need to pay close attention to your diet so that you don’t accumulate too much potassium.


Also called digitalis, this medication slows your heartrate while increasing the strength of your heart muscle contraction. Your doctor may prescribe this medication if you have a heart rhythm issue such as atrial fibrillation.

This medication has been linked to some adverse outcomes and toxicity, so it should be used carefully.


These are a class of intravenous medications usually given in a hospital setting. They help to maintain blood pressure and improve the pumping action of the heart. These drugs are only recommend for short-term use.


Another important type of cardiac medication is vasodilators, such as hydralazine and nitrates. These treatments help dilate, or relax, blood vessels. When blood vessels are relaxed, your blood pressure will lower. This helps your heart more easily pump blood.

Your doctor may also prescribe a blood thinner to reduce your risk of clotting, especially if you have cardiac rhythm issues, such as atrial fibrillation.

Your treatment will also likely focus on addressing related health conditions, such as high blood pressure, diabetes, and high cholesterol. For example, your doctor may recommend statins to treat cholesterol.

Systolic heart failure is also known as heart failure with reduced ejection fraction (HFrEF). Ejection fraction measures how much of the blood that flowed into your left ventricle is pumped out with each heartbeat.

Normal ejection fraction is usually greater than 55 percent. With systolic heart failure, your heart can’t pump as much blood out of the left ventricle as it should. Mild systolic dysfunction means a left ventricle ejection fraction of 40 to 50 percent. The condition is considered moderate at 30 to 40 percent, and severe at less than 30 percent.

The other type of left ventricle heart failure is called diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF). In this case, the left ventricle can pump properly but is unable to relax normally between beats.

Unlike treatment for systolic heart failure, treatment for diastolic heart failure tends to focus on treating related conditions. This can include high blood pressure, sleep apnea, diabetes, salt retention, and obesity. All of these conditions contribute to heart failure.

For this reason, it’s helpful to know your specific diagnosis. Your doctor can tell you if you have left ventricle heart failure, and if it is systolic or diastolic.

When you experience systolic heart failure, your body can’t circulate blood properly. Without medication, your body tries to compensate and restore this circulation. Your sympathetic nervous system activates and increases your cardiac output by making your heart beat faster and harder.

This compensation response isn’t meant to be continuously activated. This causes the receptors in your heart that activate the sympathetic nervous system to down-regulate. Your heart can’t keep up with the ongoing demand, and compensation changes to decompensation. Heart failure gets worse and the cycle continues.

Medication slows down the progression of heart failure by interrupting the sympathetic nervous system response. It helps to reduce the burden on your heart. It also plays a role in regulating cardiac output and stabilizing circulation.

Most medications have side effects, so ask your doctor what to expect from the medication you’re taking.

Common side effects from heart failure medications include dizziness, nausea, headache, and changes in appetite. Some side effects are harmless while others require prompt medical attention. Your doctor can explain which side effects are a concern and when to have them medically assessed.

An effective treatment approach for heart failure involves taking more than one medication, usually a combination of medications.

For example, trials have shown that ACE inhibitors reduce the risk of dying from heart failure by 17 percent. But adding a beta-blocker medication improves that risk reduction to as much as 35 percent. Including the aldosterone antagonist spironolactone improves the outcome even more.

A combined medication therapy can lower the risk of dying from heart failure over the next two years by as much as 50 percent.

To help your medications work well, take them as prescribed. Take the amount recommended by your doctor, at the proper times.

Pay attention to additional instructions from your doctor or pharmacist. For example, note if you can take your medication with food, and if certain foods, beverages, or vitamin supplements can interfere with how the medication works. Always ask your doctor first before taking supplements.

Write down all the medications that you take and keep the list with you. If you have any questions write those down too, and make sure to ask your doctor.

Systolic heart failure, or heart failure with reduced ejection fraction, is treatable with medication. Without medication, heart failure tends to get worse. The goal of treatment is to improve the quality of your life, reduce your risk of being hospitalized, reduce your symptoms, and improve the function of your heart.

Always take your medication as prescribed. Your doctor can tell you more about how your medication works and why they recommend it for you.