A patient with left-sided systolic dysfunction has which findings?

• A. EF 38% on echocardiogram.
• B. EF 65% on heart catheterization.
• C. Nocturnal paroxysmal dyspnea.
• D. Both EF 38% on echocardiogram and nocturnal paroxysmal dyspnea.

Answer: (D)

Left-sided systolic dysfunction means the heart’s pumping ability is reduced, so the ejection fraction (EF) falls below normal. An EF of 38% on an echocardiogram shows decreased contractility consistent with systolic heart failure. In contrast, an EF of 65% on catheterization indicates preserved systolic function, which would not align with systolic dysfunction. Nocturnal paroxysmal dyspnea is a classic symptom of left-sided heart failure: when lying down, fluid shifts toward the chest and pulmonary congestion worsens, causing sudden nighttime shortness of breath. Seeing both a reduced EF and nocturnal dyspnea fits the diagnosis of left-sided systolic dysfunction, whereas the preserved EF does not.