Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your husband's medical history and would like to explain that some clinical data like:

- a long-standing history of heart failure (around 15 years),
- HF functional class III,
- presence of atrial fibrillation,
- a markedly reduced LVEF (20-25%),
- shortness of breath while exerting

are inconvenient prognostic markers of a bad middle and long-term prognosis, unfortunately.

If the clinical scenario remain the same, then the probability of a deteriorating clinical symptomatology (dyspnea, generalized edema, extreme fatigue, life-threatening cardiac arrhythmia, low cardiac output, etc.) would keep raising.

What could be done in this unfavorable circumstances would be first optimize the current medical therapy:

- the crucial point to consider would be diuretics daily dose adjustment,

- a better control of ventricular rate response of atrial fibrillation,

- an appropriate anticoagulation considering the presence of cardiomyopathy and atrial fibrillation (to prevent dangerous cardioembolic event as well as pulmonary embolism, which are not rare in these clinical conditions),

- review of CRT (Biv pacemaker) efficacy in improving left ventricular performance,

- a better management of concomitant health disorders and potentially triggering factors for HF exacerbation (a pulmonary chronic disorder, diabetes, chronic renal disease, etc.). In this regards, it is necessary to avoid excessive use of alcoholic use. Coming to this point, even 50 ml daily alcohol would be harmful,

- iron supplements then are beneficial in heart failure patients,

- a better control of his daily fluid balance (the ratio of fluid intake and elimination).

The actual therapy seems to be acceptable, considering that the above mentioned issues would offer a better optimization and yield more clinical benefits (improve overall physical performance, reduce exertional dyspnea, eliminate pulmonary and peripheral edema, control AFib response, etc.)

In this regard, I recommend discussing with his attending doctor on the possibility of performing a careful physical evaluation and some additional test to clarify his current clinical status (investigate possible presence of pulmonary and systemic congestion):

- complete blood count,
- ferritin,
- renal and liver function tests,
- blood electrolytes level,
- fasting blood glucose,
- chest X ray study,
- plasma protein level

These would be helpful to guide therapy and life-style optimization.

Hope to have been of some help to you!

In case of any further questions, feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Regarding your concern, I could explain that the risk of serious life-threatening complications and the probability of frequent hospitalizations is quite high within the next five years.

As you can see, the near and median prognosis is not good, but I could also add that it will greatly depend on the commitment to follow a rational medical follow up and to achieve the optimization of therapy, as I mentioned above.

If this is done successfully, than the rate of adverse complications may be markedly reduced, but in the meantime, none can predict any exact percentage as it would depend on the specific clinical conditions and comorbidities of the patient.

That is my opinion.

Hope you will find this answer helpful!

Best wishes,

Dr. Iliri

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