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I went through your query and have reviewed all your reports (attachments removed to protect the patient's identity).The echocardiogram is suggestive of severe left ventricular dysfunction with low ejection fraction meaning inadequate heart pumping. That is the reason for all his symptoms. First of all, we need to evaluate the causes for his left ventricular dysfunction, which most likely could be due to coronary artery disease blockages in heart vessels. I need to know some more details about his present symptoms. Did he have chest pain on exertion or at rest anytime before? Any history of heart disease or heart attack? Does he have diabetes, hypertension, a history of smoking, or alcohol intake? Has he undergone coronary angiography? If not, then get an angiography done to see for blockages. Then we need to decide on the further line of management, either with revascularization or medical management, depending on his report. Of course, there is a need to make some changes in his medicines also. But, for the time being, you can continue the treatment as advised by your doctor. Kindly get back with the above details and investigation reports for further discussion and management. Take care.