Greetings. Thank you for your question and welcome to HCM. I understand your concern. An implantable cardioverter-defibrillator (ICD) is recommended in heart failures with 35% or lower ejection fraction. It is very helpful, but it is only one direction in which we fight heart failure. You see, when the heart is enlarged, heart muscle fibres move away from each-other and this formed gap is substituted with non-functional fibrotic (scar) tissue. It is this tissue that poses the heart to a risk of serious, malignant, life-threatening ventricular arrhythmias and sudden cardiac death. Should such an arrhythmia trigger, the ICD will immediately and automatically perform an electric shock to convert it to sinus rhythm, thus preventing sudden cardiac death. On the other side, a heart working only in 20% of its function is accompanied with a poor and progressive prognosis. This means that heart pumps only 20% of its content during one systole (55-70% considered normal). This weak heart fails to provide end-organs with sufficient oxygen and nutrients, and these organs begin to shut down as a compensatory mechanism, to protect the blood supply to the brain, hence the kidney failure. Although a poor prognosis, some measures can be taken to prolong the life (one of them being the ICD explained above). Treatment should be regular and adhered to. Among other drugs, it should also contain furosemide and spironolactone, oxygen therapy, and an angiotensiongen converting enzyme inhibitor (ACE-I: the pril family). It is recommended for the salt to be withheld altogether from the diet, because it is estimated that 1 g of salt retains 10 g of water. In a second moment, you can discuss with her cardiologist about the possibility of a cardiac resynchronization therapy (CRT - biventricular pacemaker). This enlarged left ventricle contracts significantly later than the right ventricular, so the synchronization of both ventricles is shown to be helpful, in actual studies. I hope I have been of help. My regards, Dr. Meriton