The ratio of the volume of blood ejected when the heart pumps is measured in a value of percentage. The normal limits of the measurement can depend on the type of test used to measure the change in left ventricular volume with each beat. On average, a heart at rest has an ejection fraction between 55-75%, never fully ejecting all the blood from the heart.

There are different types of heart failure and different types of pacemakers. If a patient with heart failure has a low ejection fraction despite medications and a prolonged electrical time of activation of their heart’s contraction then some patients could benefit from a special type of pacemaker called a Bi-ventricular pacemaker. A Bi-ventricular pacemaker has leads that activate the left and right ventricle and can improve the timing of the activation of the hearts contraction. If this is achieved then cardiac output is achieved and may help patients feel better and exercise further.

There are many causes for shortness of breath including a leaky mitral valve. Normally, the mitral valve allows blood into the left ventricle when it is filling and should close when the heart is contracting. When the mitral valve has a severe leak, increased fluid pressure behind the heart can cause the lungs to become distended with fluid–a condition called pulmonary edema.  Reduced forward heart delivery of blood to the body can contribute to symptoms of fatigue. A definitive therapy for severe conditions could include surgery to repair or replace the leaky valve when a patient’s general condition would permit this. Medical management through diuretics (medicines that increase the excretion of salt and water by the kidneys) may decrease fluid overload of the lungs and improve shortness of breath. Medicines that dilate blood vessels can also reduce an increased fluid pressure. A diet low in intake of sodium can reduce the fluid pressures within the circulation and also help.  A decision for surgery should be thought about carefully due to increased risks associated with older age.

Congestive heart failure has many symptoms, but the most dominant, shortness of breath, can be caused by fluid buildup in the lungs. Although inhaled oxygen might temporarily help symptoms of difficulty breathing at night, it might be better to try to get to the root causes. Fluid congestion at night can often be improved over time by reducing sodium intake in the diet or increasing the doses of diuretics.  Medicines that dilate blood vessels can also reduce vascular pressures that contribute to fluid buildup in the lungs. Your father’s doctor could also answer whether there are any treatable conditions that could fundamentally improve your father’s heart function as a pump such as excessive high blood pressure, blocked heart arteries, or impaired heart valves.

Your grandmother could experience symptoms of dizziness if her heart failure led to a frequently low  blood pressure or oxygen saturation in her blood. With advanced heart failure, memory or analytical thinking may be impaired. In general, when elderly individuals have hallucinations, causes besides heart failure that could affect brain function should be considered.