Hi. Welcome to HCM. I understand your concern. First, I would like to recommend some tests for this diagnosis. It would be reasonable to do an echocardiogram, to assess the movement of heart muscle, to confirm or exclude a recent or remote heart attack as the main cause for this heart enlargement, as well as to assess the functionality of the heart valves. Furthermore, I would recommend a series of blood tests, such as cholesterol, triglycerides, renal function tests, liver function tests and electrolytes. From the symptoms and fitness you describe, she is probably in heart failure, class II of the NYHA (New York Heart Association) classification system. Since the damage to the heart is now factual, I would recommend starting her on treatment with furosemide (Lasix) 40 mg x 1 tb/d and ramipril 2.5 mg x 2 tb/d. If ramipril is counterindicated, then she can start on losartan 25 mg x 2 tb/d. This is added therapy, while I assume she is on proper medications for established diagnoses. Also, I would recommend that she should a diet free of salt. About the skipped heartbeats, she should be put on a 24-hour Holter rhythm monitor, to establish if these events are dangerous and how often they happen during a day. Then, you can consult her cardiologist whether to start also on amiodarone 200 mg x 1 tb/d, or not. I hope I was helpful with my asnwer. Take care.