Brief Answer: please see details. Detailed Answer: Dear Sir 1. The documents state that your father has coronary artery disease and has suffered heart attacks in the past. His current pumping is very low and he is diabetic. He has severe leakage in one of his valves. He has moderately increased right sided pressures. 2. All the above things definitely make the situation grave and difficult. On the other hand the treatment as mentioned on discharge ticket has all the essential medications for heart failure as per standard international guidelines. Fortunately his hemoglobin and kidney functions are good. 3. His angiogram revealed unattended blockages to right circulation but intervention to totally occluded bypass graft is not advisable. Other methods to increase pumping include a biventricular pacemaker, however in absence of LBBB in ECG, he is not a candidate for same. Even cardiac transplant is contraindicated in patients with diabetes and end organ damage and for those with age more than 65 years. Hence things are not very good. 4. I would recommend to continue this treatment and if he still does not improve you may consult your cardiologist for few alterations in medications. That's perhaps the best scientific course for him. Although not yet proven fully, some people got some success with cardiac stem cell therapy in such cases. I am not a proponent of same but you can discuss the same with your cardiologist. I understand that to hear this is disappointing, however if there is any query I would readily answer to that. Sincerely Sukhvinder

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