Brief Answer:
Heart insufficiency

Detailed Answer:
Greetings. Welcome to HealthCare Magic and thank you for your question. I am Dr. Meriton. I understand your concern.

There is no relation between the contrast XXXXXXX and heart attacks. However, I can see that a previous major heart has dropped the heart function significantly. We are going to takes the steps together, about the precautions and possible interventions that can be made in this scenario. First, let us go through the medication: I think that this is the almost full profile of dilated cardiomyopathy treatment. I would only add spironolactone, a potassium sparing diuretic, which is highly recommended for these patients that have ejection fraction under 35% and that are class III-IV in NYHA classification of cardiac insufficiency.

A heart with 25% of function means that is able to pump forward only 25% of its content and keeps 75% of its content, during one cardiac cycle. This means two things: first, this amount of blood pumped forward is not sufficient to fulfil the peripheral organs' needs for oxygen and nutrients. Therefore every strain on this heart or every situation that demands from the heart to compensate, like physical activity, psychological stress etc., will find an insufficient heart that cannot cope with these increased end-organ needs. Second, the 75% of heart content remaining in the heart, produce a difficulty for the blood coming from lung circulation to empty into the heart. This means more blood in lung circulation - more fluid retention - increasing pressures - resulting pulmonary oedema (lung filled with fluids). In this state, organism itself recruits some compensatory mechanisms. While beneficial in first moments of heart decompensation, they quickly become hazardous to the heart. So, all the medicine used, the above mentioned, have some aims: counteracting with these mechanisms, force the heart pump to fulfil peripheral needs and reduce heart afterload and make the emptying process easier.

What should be done?
- restriction of all physical activites to simple everyday personal duties, because, as I mentioned above, every strain on the heart can result in serious, life-threatening complications of this condition.
- total restriction of salt from the diet, because it is estimated that 1 g of salt keeps 10 g of water in the human body.
- careful and constant adheration to the medication strategy
- keeping away from psychological stress as much as possible.
- oxygen supplamantation, if possible and available.
- enlarged heart is characterized by a stretch of heart muscle, and muscle cells grow away from each-other and space between them is replaced with non-functional scar tissue. Due to this phenomenon, the heart is prone to ventricular, serious, arrhythmias (that is why amiodarone and metoprolol are used). In this viewpoint, a discussion about implanting an implanted cardioverter-defibrillator (ICD) should be made, to prevent sudden death from these arrhythmias by automatically striking an electric shock to convert them, if they happen.
- in heart enlargement there is a loss of synchronization between two ventricles. This dissynchrony can be fought by implanting another device which is CRT (cardiac resynchronization therapy). Although, the benefits are higher for heart enlargement that are not due to myocardial ischemia, it is worth the discussion, because of benefits in longlivety shown by this technique in some studies.
The last two suggestions are to be discussed in another moment, when the general health is stabilized by medication, diet restrictions, and physical and psychological factor restriction.

The abdominal ultrasonography specifies only a prostatic hypertrophy, which does not constitute a priority at this moment. The other organ are fine and with non-significant changes. Cardiac insufficiency, as I described above, is a major factor of multi-organ failure because of the two major mechanisms depicted above.

I hope I was thorough with my answer. If you have follow-up questions, I am happy to help. If not, I kindly ask you to close the discussion and rate the answer. Wish him a good health.

Best regards,
Dr. Meriton

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