Brief Answer:
Multiple possibilities of fatigue. Geriatric, organic psychologic

Detailed Answer:
Thank you for asking

I read your question and i understand your concern. With history of congestive and valvular heart diseases , fatigue is all explainable. Ejection fraction of 40 % is less than what body demands. That results in to fatigue.

Apart from organic causes of fatigue, psychological causes like depression are more prevalent in old ages. Depression is notorious for unexplainable fatigue. You are already on antidepressants . Add some other measures like yoga, pilates, psychotherapies etc to help the fatigue.

You are already on cardiotonics, antihypertensives, antidepressants and anticoagulants . I would suggest some sleep aid pills like alprazolam at mid night for helping insomnia. A good sound sleep will help reduce fatigue.

Apart from that conservative management and symptomatic treatment is all we can suggest at this age of 72 due to associated geriatric limitations and comorbidities.

I hope it helps. Take good care of yourself and dont forget to close the discussion please.

Regards
Khan

---

Brief Answer:
multiple etiologies

Detailed Answer:
Thank you for explaining
With professional expertise depression as a cause of fatigue is ruled out then. How ever long term illness itself has a depressive effect. Being a therapist Helps though.

Organic causes like cardiac valvular dysfunction MS and decreased ejection fraction is likely cause then.

I would suggest reconsidering digoxin dosages and up it further. Although consider narrow therapeutic window.

One more likelihood is drug induced fatigue specially digoxin resulting in electrolytes imbalance specially potassium. So regular follow up and close look at electrolytes is advised.

I would also Consider chronic fatigue syndrome at this age. As unexplained fatigues most of the time fulfill the criteria for CFS.

I hope it helps.
Take care
Khan

---