When a person sustains a heart injury from a motor vehicle accident (MVA), the ejection fraction (EF) is a tool that detects heart damage from MVA, and guides treatment and prognosis decisions. In MVA litigation, an ejection fraction expert witness can explain how the EF value is used for detection, treatment, and prognosis of heart damage.
What is the ejection fraction?
Ejection fraction is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction.
Ejection fraction is a commonly used tool in clinical practice because it is a quick, easy, and accurate way to detect short-term and long-term heart conditions from disease or accident-related heart damage. An echocardiogram is typically used to measure a patient’s ejection fraction. In MVA litigation, an ejection fraction expert witness can be utilized to explain the what post-accident EF measurements mean.
What are normal and abnormal ranges of Ejection Fraction?
Normal and abnormal values for EF are classified per the American College of Cardiology (ACC)
Hyperdynamic: greater than 70%
Normal: 50 – 70%
Mild dysfunction: 40-49%
Moderate dysfunction: 30-39%
Severe dysfunction: less than 30%.
What do ejection fraction measurements mean?
An abnormally low EF can be a sign of heart, chest wall or heart vessel injury. A persistently low EF could indicate the need for medications or even the placement of a defibrillator to help the heart beat regularly. An ejection fraction expert witness may be called in to explain the significance of post-accident heart ejection fraction values to treatment and prognosis.
For example, a marked reduction of the left ventricular EF is a potent predictor of sudden cardiac death (SCD) in patients with accident-related heart injuries or heart disease. Increased risk, independent of other risk factors, is measurable at an ejection fraction greater than 40%, but the most significant risk change rate is between 30 and 40%. An ejection fraction equal to or less than 30% is the single most powerful independent predictor for SCD (1).
Case Studies of Use of Ejection Fraction after MVA
Case 1: Using the EF to evaluate prognosis following MVA:
A 62-year-old man, business manager, developed myocardial infarction in a MVA with symptoms of heart failure. He was evaluated in the emergency department for shortness of breath and palpitations. Shortly after being admitted to the ED, the patient developed an episode of ventricular fibrillation and went into cardiac arrest. After two shocks, normal sinus rhythm returned.
An echocardiogram demonstrated an enlarged left ventricle poorly contracting with an ejection fraction of 11%. The ejection fraction was a critically low number and placed him at high risk of sudden cardiac death. The patient was treated with the insertion of a pacemaker and automatic implantable cardioverter-defibrillator (AICD).
In such a case, an ejection fraction expert witness can address whether heart medications and the defibrillator reduced the risk of sudden cardiac death and improved survival outlook.
Case 2: Using the EF to manage patient following MVA:
A 57-year-old female cashier was involved in a serious MVA. She was a restrained vehicle driver, traveling approximately 35 mph when she struck another car head-on. She denied loss of consciousness but had sternal area chest pain. Airbags deployed. Echocardiogram on admission showed estimated ejection fraction was 20-25%, significantly depressed, and repeated EF 8 days later returned to a normal level of 60-65%. In addition to orthopedic injuries, the patient suffered a cardiac contusion with a reduced myocardial blood flow causing persistent dysfunction (stunning) of the heart muscle.
The patient was monitored with repeat EF measurements over the next few weeks and received follow-up care.
Here again, an ejection fraction expert witness could assess whether these successive EF values affected the patient’s clinical outcome and prognosis.
Conclusion
In MVA and other litigation resulting from heart injury or heart damage, an ejection fraction expert witness may assist the trier of fact in understanding what the EF value means, and how the EF can detect, treat, and prognosticate heart injury.
References:
- Braunwald’s Heart Disease. 7th Edition, Vol. 1, 2005. Page 495 and 871).
- Traumatic blunt cardiac injuries: An updated narrative review. Int J Crit Illn Sci, 2019 Jul-Sep; 9(3): 113-119.
- Cardiac Trauma. https://www.ncbi.nlm.nih.gov/booksNBK430725/
About the Author
John R. Filip, MD is a board-certified, fellowship-trained physician specializing in cardiology and internal medicine, with over 40 years’ experience in active cardiology and internal medicine practice. Filip has wide medical legal experience in trauma, motor vehicle accidents and undiagnosed myocardial contusion injuries. He can be reached at (610) 659-7960 or johnfilip@mac.com.
