Systolic Heart Failure

What is systolic heart failure?

Systolic heart failure is a form of heart failure in which the heart’s lower chambers (ventricles) have become too weak to contract and pump out enough blood to meet the body’s needs, resulting in shortness of breath and other heart failure symptoms.

Click here for an illustration of the difference between systolic and diastolic heart failure.

Women are less likely than men to have systolic heart failure, accounting for about 25% to 35% of systolic heart failure cases.1-3 Men have double the risk of developing blood-pumping (systolic) problems compared with women, and when women do develop them they tend to be less severe.4

Researchers think that the reason for this difference is that the main pumping chamber (left ventricle) in women responds differently to conditions that cause it to work harder to pump out blood, such as high blood pressure, coronary artery disease, and narrowing of the aorta (the main artery that carries blood from the heart to the body).5-7 Studies have found that in women the pumping chamber wall thickens but the pumping chamber itself doesn’t enlarge; in men, the chamber stretches and enlarges but the wall doesn’t thicken, leading to reduced blood-pumping function.5, 8, 9 As a result, women usually have better blood-pumping function and a higher ejection fraction (the percentage of blood pumped out per heartbeat) than men9-12 and are more likely to have diastolic heart failure, in which the thickened wall can’t relax as easily for the chamber to expand and fill with enough blood.

What are the symptoms of systolic heart failure?

The symptoms of heart failure are generally the same whether you have systolic heart failure or diastolic heart failure. Women with long-term systolic heart failure are more likely than men to have symptoms such as swollen ankles (22% vs. 15%), elevated pressure in the jugular veins on each side of the neck (17% vs. 5%), and shortness of breath resulting from fluid buildup in the lungs.13 Click here for more information on the signs and symptoms of heart failure.

What causes systolic heart failure?

Systolic heart failure can be caused by any condition that impairs the heart muscle’s ability to pump blood. The most common causes of systolic heart failure are coronary artery disease (CAD) and high blood pressure, either on their own or together.

CAD is a major cause of systolic heart failure in women,14 although women are less likely than men to have heart failure caused by CAD or heart attack.9, 11, 12, 14, 15 Limited blood flow through narrowed blood vessels can weaken and damage the heart muscle, making it difficult for the heart to contract and pump out blood. Women who do have a heart attack are more likely than men to develop systolic heart failure.14 Click here for more detailed information on how CAD increases your risk of heart failure.

Women are more likely than men to have high blood pressure before developing heart failure.6, 11, 14-18 High blood pressure causes the heart to work harder to pump out blood against the increased pressure in the arteries. Over time, this weakens the heart muscle, damaging its ability to contract and pump blood. Click here for more detailed information on how high blood pressure increases your risk of heart failure.

Diabetes is another important contributor to systolic heart failure in women.15 Women with systolic heart failure are more likely than men to have diabetes.14, 15, 19 Diabetes itself can cause heart failure by directly damaging the heart muscle,20 but it can also lead to systolic heart failure indirectly by accelerating the development of CAD and high blood pressure.21 Women with diabetes have four times the risk of dying of heart disease than women without diabetes.22 Click here for more detailed information on how diabetes increases your risk of heart failure.

While for some people there may be one main cause of systolic heart failure, most have multiple factors that work together to cause a gradual decline in the heart’s pumping ability. For more information on the risk factors for heart failure, see our Am I At Risk section.

Who is at risk for systolic heart failure?

Elderly women and women with a current or past history of high blood pressure, CAD, heart attack, or diabetes are at the highest risk for systolic heart failure.

Drugs & Conditions